pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	mrx_tier_id	mrx_tier_label_list	mrx_tier_type_id	mrx_tier_benefit_type	mrx_tier_drug_type	mrx_tier_includes	mrx_tier_cstshr_struct_type	mrx_tier_locat_in	mrx_tier_locat_inp	mrx_tier_locat_oon	mrx_tier_locat_mo	mrx_tier_locat_mop	mrx_tier_locat_ltc	mrx_tier_inp_1m_num	mrx_tier_inp_2m_num	mrx_tier_inp_3m_num	mrx_tier_inpp_1m_num	mrx_tier_inpp_2m_num	mrx_tier_inpp_3m_num	mrx_tier_extd_days_yn	mrx_tier_mo_1m_num	mrx_tier_mo_2m_num	mrx_tier_mo_3m_num	mrx_tier_mopp_1m_num	mrx_tier_mopp_2m_num	mrx_tier_mopp_3m_num	mrx_tier_oonp_1m_num	mrx_tier_oonp_othnumn	mrx_tier_ltcp_1m	mrx_tier_inp_copay_daily	mrx_tier_inp_copay_1m	mrx_tier_inp_copay_2m	mrx_tier_inp_copay_3m	mrx_tier_inp_coins_avg_1m	mrx_tier_inp_coins_1m	mrx_tier_inp_coins_2m	mrx_tier_inp_coins_3m	mrx_tier_inpp_copay_daily	mrx_tier_inpp_copay_1m	mrx_tier_inpp_copay_2m	mrx_tier_inpp_copay_3m	mrx_tier_inpp_coins_avg_1m	mrx_tier_inpp_coins_1m	mrx_tier_inpp_coins_2m	mrx_tier_inpp_coins_3m	mrx_tier_innpp_copay_daily	mrx_tier_innpp_copay_1m	mrx_tier_innpp_copay_2m	mrx_tier_innpp_copay_3m	mrx_tier_innpp_coins_avg_1m	mrx_tier_innpp_coins_1m	mrx_tier_innpp_coins_2m	mrx_tier_innpp_coins_3m	mrx_tier_mo_copay_daily	mrx_tier_mo_copay_1m	mrx_tier_mo_copay_2m	mrx_tier_mo_copay_3m	mrx_tier_mo_coins_1m	mrx_tier_mo_coins_2m	mrx_tier_mo_coins_3m	mrx_tier_mopp_copay_daily	mrx_tier_mopp_copay_1m	mrx_tier_mopp_copay_2m	mrx_tier_mopp_copay_3m	mrx_tier_mopp_coins_1m	mrx_tier_mopp_coins_2m	mrx_tier_mopp_coins_3m	mrx_tier_monpp_copay_daily	mrx_tier_monpp_copay_1m	mrx_tier_monpp_copay_2m	mrx_tier_monpp_copay_3m	mrx_tier_monpp_coins_1m	mrx_tier_monpp_coins_2m	mrx_tier_monpp_coins_3m	mrx_tier_oonp_copay_1m	mrx_tier_oonp_copay_othnum	mrx_tier_oonp_coins_1m	mrx_tier_oonp_coins_othnum	mrx_tier_ltcp_copay_daily	mrx_tier_ltcp_copay_1m	mrx_tier_ltcp_coins_1m	mrx_tier_form_model_desc	mrx_tier_includes_mmp	mrx_tier_copay_amt_inp_mmpmin	mrx_tier_copay_amt_inp_mmpmax	mrx_tier_copay_amt_oon_mmpmin	mrx_tier_copay_amt_oon_mmpmax	mrx_tier_copay_amt_mo_mmpmin	mrx_tier_copay_amt_mo_mmpmax	mrx_tier_copay_amt_ltc_mmpmin	mrx_tier_copay_amt_ltc_mmpmax	mrx_tier_gap_cost_share	mrx_tier_gap_part_drugs	mrx_tier_gap_part_includes
H0022	001	0	1	48	05	H0022_001_0	4	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0022	001	0	1	48	05	H0022_001_0	4	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H0022	001	0	1	48	05	H0022_001_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2											
H0028	001	0	1	01	01	H0028_001_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	001	0	1	01	01	H0028_001_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	001	0	1	01	01	H0028_001_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	001	0	1	01	01	H0028_001_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	001	0	1	01	01	H0028_001_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0028	001	0	1	01	01	H0028_001_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0028	001	0	1	01	01	H0028_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	001	0	1	01	01	H0028_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	001	0	1	01	01	H0028_001_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	001	0	1	01	01	H0028_001_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	002	0	1	01	01	H0028_002_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	002	0	1	01	01	H0028_002_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	002	0	1	01	01	H0028_002_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	002	0	1	01	01	H0028_002_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	002	0	1	01	01	H0028_002_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	002	0	1	01	01	H0028_002_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0028	002	0	1	01	01	H0028_002_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	002	0	1	01	01	H0028_002_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	002	0	1	01	01	H0028_002_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	002	0	1	01	01	H0028_002_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0028	003	0	1	01	01	H0028_003_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	003	0	1	01	01	H0028_003_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	003	0	1	01	01	H0028_003_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	003	0	1	01	01	H0028_003_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	003	0	1	01	01	H0028_003_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	003	0	1	01	01	H0028_003_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	003	0	1	01	01	H0028_003_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	003	0	1	01	01	H0028_003_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0028	003	0	1	01	01	H0028_003_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0028	003	0	1	01	01	H0028_003_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	004	0	1	01	01	H0028_004_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	004	0	1	01	01	H0028_004_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	004	0	1	01	01	H0028_004_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	004	0	1	01	01	H0028_004_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	004	0	1	01	01	H0028_004_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0028	004	0	1	01	01	H0028_004_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	004	0	1	01	01	H0028_004_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0028	004	0	1	01	01	H0028_004_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	004	0	1	01	01	H0028_004_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	004	0	1	01	01	H0028_004_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	005	0	1	01	01	H0028_005_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	005	0	1	01	01	H0028_005_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	005	0	1	01	01	H0028_005_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	005	0	1	01	01	H0028_005_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	005	0	1	01	01	H0028_005_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	001	0	1	04	01	H0084_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	001	0	1	04	01	H0084_001_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	001	0	1	04	01	H0084_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															20.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	001	0	1	04	01	H0084_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					993.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	001	0	1	04	01	H0084_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	004	0	1	04	01	H0084_004_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	004	0	1	04	01	H0084_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.30	9.00		27.00																															18.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	004	0	1	04	01	H0084_004_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	004	0	1	04	01	H0084_004_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	004	0	1	04	01	H0084_004_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					687.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	064	0	1	04	01	H0084_064_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	064	0	1	04	01	H0084_064_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															20.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	064	0	1	04	01	H0084_064_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	064	0	1	04	01	H0084_064_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	064	0	1	04	01	H0084_064_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					826.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	065	0	1	04	01	H0084_065_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.30	9.00		27.00																															18.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	065	0	1	04	01	H0084_065_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	065	0	1	04	01	H0084_065_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	065	0	1	04	01	H0084_065_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					545.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0084	065	0	1	04	01	H0084_065_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	1	1	04	01	H0104_010_1	4	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		8.00					.13	4.00		12.00					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	1	1	04	01	H0104_010_1	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.40	12.00		24.00					.40	12.00		36.00					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	1	1	04	01	H0104_010_1	4	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	1	1	04	01	H0104_010_1	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									2.50	75.00		150.00					2.50	75.00		225.00					2.50	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	1	1	04	01	H0104_010_1	4	5	Specialty Tier	1	4	010010	1	1		110	01	110		1				30		90	1	30		90				30		31														33		33						33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	2	1	04	01	H0104_010_2	4	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		8.00					.13	4.00		12.00					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	2	1	04	01	H0104_010_2	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.40	12.00		24.00					.40	12.00		36.00					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	2	1	04	01	H0104_010_2	4	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	2	1	04	01	H0104_010_2	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									2.50	75.00		150.00					2.50	75.00		225.00					2.50	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	2	1	04	01	H0104_010_2	4	5	Specialty Tier	1	4	010010	1	1		110	01	110		1				30		90	1	30		90				30		31														33		33						33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	3	1	04	01	H0104_010_3	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.40	12.00		24.00					.40	12.00		36.00					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	3	1	04	01	H0104_010_3	4	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		8.00					.13	4.00		12.00					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	3	1	04	01	H0104_010_3	4	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	3	1	04	01	H0104_010_3	4	5	Specialty Tier	1	4	010010	1	1		110	01	110		1				30		90	1	30		90				30		31														33		33						33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	3	1	04	01	H0104_010_3	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									2.50	75.00		150.00					2.50	75.00		225.00					2.50	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	4	1	04	01	H0104_010_4	4	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		8.00					.13	4.00		12.00					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	4	1	04	01	H0104_010_4	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.40	12.00		24.00					.40	12.00		36.00					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	4	1	04	01	H0104_010_4	4	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	4	1	04	01	H0104_010_4	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									2.50	75.00		150.00					2.50	75.00		225.00					2.50	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	4	1	04	01	H0104_010_4	4	5	Specialty Tier	1	4	010010	1	1		110	01	110		1				30		90	1	30		90				30		31														33		33						33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	5	1	04	01	H0104_010_5	4	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		8.00					.13	4.00		12.00					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	5	1	04	01	H0104_010_5	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.40	12.00		24.00					.40	12.00		36.00					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	5	1	04	01	H0104_010_5	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									2.50	75.00		150.00					2.50	75.00		225.00					2.50	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	5	1	04	01	H0104_010_5	4	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	010	5	1	04	01	H0104_010_5	4	5	Specialty Tier	1	4	010010	1	1		110	01	110		1				30		90	1	30		90				30		31														33		33						33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	1	1	04	01	H0104_011_1	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		20.00					.33	10.00		30.00					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	1	1	04	01	H0104_011_1	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		8.00					.13	4.00		12.00					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	1	1	04	01	H0104_011_1	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	1	1	04	01	H0104_011_1	4	5	Specialty Tier	1	3	010010	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	25		25					1.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	1	1	04	01	H0104_011_1	4	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.16	95.00		190.00					3.16	95.00		285.00					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	2	1	04	01	H0104_011_2	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		20.00					.33	10.00		30.00					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	2	1	04	01	H0104_011_2	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		8.00					.13	4.00		12.00					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	2	1	04	01	H0104_011_2	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	2	1	04	01	H0104_011_2	4	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.16	95.00		190.00					3.16	95.00		285.00					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	2	1	04	01	H0104_011_2	4	5	Specialty Tier	1	3	010010	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	25		25					1.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	3	1	04	01	H0104_011_3	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		8.00					.13	4.00		12.00					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	3	1	04	01	H0104_011_3	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		20.00					.33	10.00		30.00					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	3	1	04	01	H0104_011_3	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	3	1	04	01	H0104_011_3	4	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.16	95.00		190.00					3.16	95.00		285.00					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	3	1	04	01	H0104_011_3	4	5	Specialty Tier	1	3	010010	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	25		25					1.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	4	1	04	01	H0104_011_4	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		20.00					.33	10.00		30.00					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	4	1	04	01	H0104_011_4	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		8.00					.13	4.00		12.00					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	4	1	04	01	H0104_011_4	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	4	1	04	01	H0104_011_4	4	5	Specialty Tier	1	3	010010	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	25		25					1.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	4	1	04	01	H0104_011_4	4	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.16	95.00		190.00					3.16	95.00		285.00					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	5	1	04	01	H0104_011_5	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		8.00					.13	4.00		12.00					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	5	1	04	01	H0104_011_5	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		20.00					.33	10.00		30.00					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	5	1	04	01	H0104_011_5	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	5	1	04	01	H0104_011_5	4	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.16	95.00		190.00					3.16	95.00		285.00					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	5	1	04	01	H0104_011_5	4	5	Specialty Tier	1	3	010010	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	25		25					1.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	6	1	04	01	H0104_011_6	5	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		8.00					.13	4.00		12.00					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	6	1	04	01	H0104_011_6	5	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.33	10.00		20.00					.33	10.00		30.00					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	6	1	04	01	H0104_011_6	5	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	6	1	04	01	H0104_011_6	5	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.16	95.00		190.00					3.16	95.00		285.00					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0104	011	6	1	04	01	H0104_011_6	5	5	Specialty Tier	1	3	010010	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	25		25					1.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	10	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.33	10.00		30.00					0.50	15.00		45.00								25.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	10	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	2			90				30		31													198.00	33		33					198.00	33		33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.00	90.00		270.00					3.17	95.00		285.00								225.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.33	40.00		120.00					1.50	45.00		135.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	11	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	2			90				30		31													198.00	33		33					198.00	33		33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	11	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.67	80.00		240.00					3.17	95.00		285.00								200.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.07	2.00		6.00					0.23	7.00		21.00								5.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	11	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	11	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.17	35.00		105.00					1.50	45.00		135.00								88.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	004	0	1	01	01	H0108_004_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	004	0	1	01	01	H0108_004_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	004	0	1	01	01	H0108_004_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	004	0	1	01	01	H0108_004_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	004	0	1	01	01	H0108_004_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	004	0	1	01	01	H0108_004_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0108	004	0	1	01	01	H0108_004_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	004	0	1	01	01	H0108_004_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	004	0	1	01	01	H0108_004_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	004	0	1	01	01	H0108_004_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	005	0	1	01	01	H0108_005_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	005	0	1	01	01	H0108_005_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	005	0	1	01	01	H0108_005_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	005	0	1	01	01	H0108_005_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	005	0	1	01	01	H0108_005_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	005	0	1	01	01	H0108_005_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	005	0	1	01	01	H0108_005_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	005	0	1	01	01	H0108_005_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	005	0	1	01	01	H0108_005_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	005	0	1	01	01	H0108_005_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	006	0	1	01	01	H0108_006_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	006	0	1	01	01	H0108_006_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.26	68.00		204.00																												2.26	68.00		194.00				2.26	68.00		204.00				68.00				2.19	68.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	006	0	1	01	01	H0108_006_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	006	0	1	01	01	H0108_006_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	006	0	1	01	01	H0108_006_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	006	0	1	01	01	H0108_006_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.80	24.00		72.00																												0.80	24.00		62.00				0.80	24.00		72.00				24.00				0.77	24.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	006	0	1	01	01	H0108_006_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.26	68.00		204.00																												2.26	68.00		194.00				2.26	68.00		204.00				68.00				2.19	68.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	006	0	1	01	01	H0108_006_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	006	0	1	01	01	H0108_006_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.80	24.00		72.00																												0.80	24.00		62.00				0.80	24.00		72.00				24.00				0.77	24.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	006	0	1	01	01	H0108_006_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	008	0	1	01	01	H0108_008_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	008	0	1	01	01	H0108_008_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	008	0	1	01	01	H0108_008_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	008	0	1	01	01	H0108_008_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	008	0	1	01	01	H0108_008_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	008	0	1	01	01	H0108_008_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	008	0	1	01	01	H0108_008_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	008	0	1	01	01	H0108_008_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	008	0	1	01	01	H0108_008_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	008	0	1	01	01	H0108_008_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	009	0	1	02	01	H0108_009_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	009	0	1	02	01	H0108_009_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	009	0	1	02	01	H0108_009_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	009	0	1	02	01	H0108_009_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	009	0	1	02	01	H0108_009_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	009	0	1	02	01	H0108_009_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	009	0	1	02	01	H0108_009_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	009	0	1	02	01	H0108_009_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	009	0	1	02	01	H0108_009_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	009	0	1	02	01	H0108_009_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	010	0	1	01	01	H0108_010_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	010	0	1	01	01	H0108_010_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	010	0	1	01	01	H0108_010_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	010	0	1	01	01	H0108_010_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	010	0	1	01	01	H0108_010_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	010	0	1	01	01	H0108_010_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	010	0	1	01	01	H0108_010_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	010	0	1	01	01	H0108_010_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	010	0	1	01	01	H0108_010_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	010	0	1	01	01	H0108_010_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	011	0	1	01	01	H0108_011_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	011	0	1	01	01	H0108_011_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	011	0	1	01	01	H0108_011_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	011	0	1	01	01	H0108_011_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	011	0	1	01	01	H0108_011_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	011	0	1	01	01	H0108_011_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	011	0	1	01	01	H0108_011_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	011	0	1	01	01	H0108_011_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	011	0	1	01	01	H0108_011_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	011	0	1	01	01	H0108_011_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	013	0	1	01	01	H0108_013_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	013	0	1	01	01	H0108_013_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	013	0	1	01	01	H0108_013_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	013	0	1	01	01	H0108_013_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	013	0	1	01	01	H0108_013_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	013	0	1	01	01	H0108_013_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	013	0	1	01	01	H0108_013_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	013	0	1	01	01	H0108_013_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	013	0	1	01	01	H0108_013_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	013	0	1	01	01	H0108_013_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	021	0	1	01	01	H0108_021_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	021	0	1	01	01	H0108_021_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	021	0	1	01	01	H0108_021_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	021	0	1	01	01	H0108_021_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	021	0	1	01	01	H0108_021_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	021	0	1	01	01	H0108_021_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	021	0	1	01	01	H0108_021_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	021	0	1	01	01	H0108_021_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	021	0	1	01	01	H0108_021_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	021	0	1	01	01	H0108_021_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	022	0	1	01	01	H0108_022_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	022	0	1	01	01	H0108_022_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	022	0	1	01	01	H0108_022_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	022	0	1	01	01	H0108_022_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	022	0	1	01	01	H0108_022_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	022	0	1	01	01	H0108_022_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0108	022	0	1	01	01	H0108_022_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	022	0	1	01	01	H0108_022_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	022	0	1	01	01	H0108_022_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	022	0	1	01	01	H0108_022_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	023	0	1	01	01	H0108_023_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	023	0	1	01	01	H0108_023_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	023	0	1	01	01	H0108_023_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	023	0	1	01	01	H0108_023_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	023	0	1	01	01	H0108_023_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	023	0	1	01	01	H0108_023_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	023	0	1	01	01	H0108_023_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	023	0	1	01	01	H0108_023_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	023	0	1	01	01	H0108_023_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	023	0	1	01	01	H0108_023_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	024	0	1	01	01	H0108_024_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	024	0	1	01	01	H0108_024_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	024	0	1	01	01	H0108_024_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	024	0	1	01	01	H0108_024_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	024	0	1	01	01	H0108_024_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	024	0	1	01	01	H0108_024_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0108	024	0	1	01	01	H0108_024_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	024	0	1	01	01	H0108_024_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	024	0	1	01	01	H0108_024_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	024	0	1	01	01	H0108_024_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	025	0	1	01	01	H0108_025_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	025	0	1	01	01	H0108_025_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	025	0	1	01	01	H0108_025_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	025	0	1	01	01	H0108_025_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	025	0	1	01	01	H0108_025_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	025	0	1	01	01	H0108_025_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	025	0	1	01	01	H0108_025_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	025	0	1	01	01	H0108_025_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	025	0	1	01	01	H0108_025_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	025	0	1	01	01	H0108_025_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	026	0	1	01	01	H0108_026_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	026	0	1	01	01	H0108_026_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	026	0	1	01	01	H0108_026_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	026	0	1	01	01	H0108_026_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	026	0	1	01	01	H0108_026_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	026	0	1	01	01	H0108_026_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	026	0	1	01	01	H0108_026_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	026	0	1	01	01	H0108_026_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	026	0	1	01	01	H0108_026_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	026	0	1	01	01	H0108_026_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0108	027	0	1	01	01	H0108_027_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	027	0	1	01	01	H0108_027_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	027	0	1	01	01	H0108_027_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	027	0	1	01	01	H0108_027_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	027	0	1	01	01	H0108_027_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	027	0	1	01	01	H0108_027_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	027	0	1	01	01	H0108_027_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	027	0	1	01	01	H0108_027_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	027	0	1	01	01	H0108_027_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	027	0	1	01	01	H0108_027_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	028	0	1	01	01	H0108_028_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	028	0	1	01	01	H0108_028_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	028	0	1	01	01	H0108_028_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	028	0	1	01	01	H0108_028_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	028	0	1	01	01	H0108_028_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	028	0	1	01	01	H0108_028_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0108	028	0	1	01	01	H0108_028_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	028	0	1	01	01	H0108_028_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	028	0	1	01	01	H0108_028_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	028	0	1	01	01	H0108_028_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	034	0	1	01	01	H0108_034_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	034	0	1	01	01	H0108_034_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	034	0	1	01	01	H0108_034_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	034	0	1	01	01	H0108_034_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	034	0	1	01	01	H0108_034_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	034	0	1	01	01	H0108_034_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	034	0	1	01	01	H0108_034_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	034	0	1	01	01	H0108_034_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	034	0	1	01	01	H0108_034_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	034	0	1	01	01	H0108_034_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0108	035	0	1	01	01	H0108_035_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	035	0	1	01	01	H0108_035_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	035	0	1	01	01	H0108_035_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	035	0	1	01	01	H0108_035_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	035	0	1	01	01	H0108_035_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0108	035	0	1	01	01	H0108_035_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	035	0	1	01	01	H0108_035_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	035	0	1	01	01	H0108_035_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	035	0	1	01	01	H0108_035_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	035	0	1	01	01	H0108_035_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	036	0	1	01	01	H0108_036_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	036	0	1	01	01	H0108_036_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	036	0	1	01	01	H0108_036_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	036	0	1	01	01	H0108_036_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	036	0	1	01	01	H0108_036_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	036	0	1	01	01	H0108_036_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	036	0	1	01	01	H0108_036_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	036	0	1	01	01	H0108_036_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	036	0	1	01	01	H0108_036_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0108	036	0	1	01	01	H0108_036_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	037	0	1	01	01	H0108_037_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	037	0	1	01	01	H0108_037_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	037	0	1	01	01	H0108_037_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	037	0	1	01	01	H0108_037_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	037	0	1	01	01	H0108_037_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	037	0	1	01	01	H0108_037_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0108	037	0	1	01	01	H0108_037_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	037	0	1	01	01	H0108_037_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	037	0	1	01	01	H0108_037_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	037	0	1	01	01	H0108_037_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	038	0	1	01	01	H0108_038_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	038	0	1	01	01	H0108_038_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	038	0	1	01	01	H0108_038_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	038	0	1	01	01	H0108_038_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	038	0	1	01	01	H0108_038_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	038	0	1	01	01	H0108_038_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0108	038	0	1	01	01	H0108_038_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	038	0	1	01	01	H0108_038_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	038	0	1	01	01	H0108_038_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	038	0	1	01	01	H0108_038_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	039	0	1	01	01	H0108_039_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	039	0	1	01	01	H0108_039_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	039	0	1	01	01	H0108_039_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	26																														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	039	0	1	01	01	H0108_039_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	039	0	1	01	01	H0108_039_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	040	0	1	01	01	H0108_040_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	040	0	1	01	01	H0108_040_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	040	0	1	01	01	H0108_040_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	040	0	1	01	01	H0108_040_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	040	0	1	01	01	H0108_040_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	041	0	1	01	01	H0108_041_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	041	0	1	01	01	H0108_041_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	041	0	1	01	01	H0108_041_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	041	0	1	01	01	H0108_041_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	041	0	1	01	01	H0108_041_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	042	0	1	01	01	H0108_042_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	042	0	1	01	01	H0108_042_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	042	0	1	01	01	H0108_042_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	042	0	1	01	01	H0108_042_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	042	0	1	01	01	H0108_042_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	043	0	1	01	01	H0108_043_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	043	0	1	01	01	H0108_043_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.30	9.00		27.00																												0.30	9.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	043	0	1	01	01	H0108_043_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	043	0	1	01	01	H0108_043_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	043	0	1	01	01	H0108_043_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	044	0	1	01	01	H0108_044_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	044	0	1	01	01	H0108_044_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	044	0	1	01	01	H0108_044_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	044	0	1	01	01	H0108_044_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	044	0	1	01	01	H0108_044_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	045	0	1	01	01	H0108_045_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	045	0	1	01	01	H0108_045_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	045	0	1	01	01	H0108_045_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	045	0	1	01	01	H0108_045_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	045	0	1	01	01	H0108_045_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	045	0	1	01	01	H0108_045_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	045	0	1	01	01	H0108_045_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	045	0	1	01	01	H0108_045_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0108	045	0	1	01	01	H0108_045_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	045	0	1	01	01	H0108_045_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	046	0	1	01	01	H0108_046_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	046	0	1	01	01	H0108_046_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	046	0	1	01	01	H0108_046_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	046	0	1	01	01	H0108_046_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	046	0	1	01	01	H0108_046_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	046	0	1	01	01	H0108_046_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	046	0	1	01	01	H0108_046_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0108	046	0	1	01	01	H0108_046_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0108	046	0	1	01	01	H0108_046_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0108	046	0	1	01	01	H0108_046_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0117	005	0	1	01	01	H0117_005_0	7	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0117	005	0	1	01	01	H0117_005_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.70	22.00	44.00	66.00												.48	15.00	30.00	30.00				.70	22.00	44.00	66.00				22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0117	005	0	1	01	01	H0117_005_0	7	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0117	005	0	1	01	01	H0117_005_0	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.22	69.00	138.00	207.00					2.70	84.00	168.00	252.00												2.22	69.00	138.00	138.00				2.70	84.00	168.00	252.00				84.00				2.70	84.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0117	005	0	1	01	01	H0117_005_0	7	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0117	007	0	1	01	01	H0117_007_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.32	10.00	20.00	30.00												0.00	0.00	0.00	0.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0117	007	0	1	01	01	H0117_007_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.12	4.00	8.00	12.00					.64	20.00	40.00	60.00												.12	4.00	8.00	8.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0117	007	0	1	01	01	H0117_007_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.64	20.00	40.00	60.00					1.45	45.00	90.00	135.00												.64	20.00	40.00	40.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0117	007	0	1	01	01	H0117_007_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.61	50.00	100.00	150.00					3.06	95.00	190.00	285.00												1.61	50.00	100.00	100.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0117	007	0	1	01	01	H0117_007_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0137	001	0	1	48	05	H0137_001_0	2	1	Generic Drugs	1	4	010000			111		10	111		1	31	60	90				2	31	60	90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0137	001	0	1	48	05	H0137_001_0	2	2	Brand Drugs	1	4	000010			111		10	111		1	31	60	90				2	31	60	90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0137	001	0	1	48	05	H0137_001_0	2	6	Non-Medicare OTC Brand Drugs	1	4	000010			111		10	111		1	31	60	90				2	31	60	90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0137	001	0	1	48	05	H0137_001_0	2	4	Non-Medicare Rx Brand Drugs	1	4	000010			111		10	111		1	31	60	90				2	31	60	90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0137	001	0	1	48	05	H0137_001_0	2	5	Non-Medicare OTC Generic Drugs	1	4	010000			111		10	111		1	31	60	90				2	31	60	90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0137	001	0	1	48	05	H0137_001_0	2	3	Non-Medicare Rx Generic Drugs	1	4	010000			111		10	111		1	31	60	90				2	31	60	90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0141	001	0	1	01	01	H0141_001_0	13	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				2			90				30		31	1.50	45.00	90.00	135.00																								135.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	001	0	1	01	01	H0141_001_0	13	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				2			90				30		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	001	0	1	01	01	H0141_001_0	13	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	3.16	95.00	190.00	285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	001	0	1	01	01	H0141_001_0	13	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					372.41	25																							25																			25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	002	0	1	01	01	H0141_002_0	11	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		60.00																								60.00																		30.00				.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	002	0	1	01	01	H0141_002_0	11	1	Generic	1	4	010000	1	2	110		01			1	30		90				2							30		31	.17	5.00		10.00																																										5.00				.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	002	0	1	01	01	H0141_002_0	11	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.33	70.00		140.00																								140.00																		70.00				2.26	70.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	002	0	1	01	01	H0141_002_0	11	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					372.41	25																							25																			25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0147	001	0	1	48	05	H0147_001_0	8	5	Non-Medicare OTC Brand Drugs	1	4	010010			010		10			1	31														10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Brand Drugs	2	0.00	3.00	0.00	3.00			0.00	0.00			
H0147	001	0	1	48	05	H0147_001_0	8	4	Non-Medicare Rx Brand Drugs	1	4	000010			010		10			1	31														10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Brand Drugs	2	0.00	3.00	0.00	3.00			0.00	0.00			
H0147	001	0	1	48	05	H0147_001_0	8	1	Generic Drugs	1	4	001001			111		10	100		1	31	62	93				2			93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Brand Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0147	001	0	1	48	05	H0147_001_0	8	2	Brand Drugs	1	4	100100			111		10	100		1	31	62	93				2			93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Brand Drugs	1											
H0147	001	0	1	48	05	H0147_001_0	8	3	Non-Medicare Rx Generic Drugs	1	4	010000			010		10			1	31														10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Brand Drugs	2	0.00	1.00	0.00	1.00			0.00	0.00			
H0148	001	0	1	48	05	H0148_001_0	5	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		10			1	30														10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H0148	001	0	1	48	05	H0148_001_0	5	2	Brand Drugs	1	4	000010			110		10	100		1	30		90				2			90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H0148	001	0	1	48	05	H0148_001_0	5	1	Generic Drugs	1	4	010000			110		10	100		1	30		90				2			90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H0148	002	0	1	48	05	H0148_002_0	1	1	Generic Drugs	1	4	010000			110		10	100		1	30		90				2			90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H0148	002	0	1	48	05	H0148_002_0	1	2	Brand Drugs	1	4	000010			110		10	100		1	30		90				2			90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H0148	002	0	1	48	05	H0148_002_0	1	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		10			1	30														10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H0150	001	0	1	01	01	H0150_001_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	001	0	1	01	01	H0150_001_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	001	0	1	01	01	H0150_001_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	001	0	1	01	01	H0150_001_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00		245.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	001	0	1	01	01	H0150_001_0	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0150	001	0	1	01	01	H0150_001_0	3	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0150	001	0	1	01	01	H0150_001_0	3	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					610.60	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	001	0	1	01	01	H0151_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					591.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	001	0	1	01	01	H0151_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	001	0	1	01	01	H0151_001_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	001	0	1	01	01	H0151_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	001	0	1	01	01	H0151_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.23	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	025	0	1	01	01	H0151_025_0	7	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					522.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	025	0	1	01	01	H0151_025_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	025	0	1	01	01	H0151_025_0	7	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	025	0	1	01	01	H0151_025_0	7	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	025	0	1	01	01	H0151_025_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.23	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	001	0	1	01	01	H0154_001_0	5	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	29							1.00	29																										29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	001	0	1	01	01	H0154_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.50	15.00		45.00					.50	15.00		45.00															37.50							45.00				15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	001	0	1	01	01	H0154_001_0	5	3	Preferred Brand	1	4	000001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.50	45.00		135.00															112.50							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	001	0	1	01	01	H0154_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01		100	1				30		90	1						90	30		31									3.16	95.00		285.00					3.16	95.00		285.00															237.50							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	001	0	1	01	01	H0154_001_0	5	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									0.00	0.00		0.00					.13	4.00		12.00															10.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.50	15.00		45.00					.50	15.00		45.00															37.50							45.00				15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	7	3	Preferred Brand	1	4	000001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.50	45.00		135.00															112.50							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01		100	1				30		90	1						90	30		31									3.16	95.00		285.00					3.16	95.00		285.00															237.50							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	7	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									0.00	0.00		0.00					.13	4.00		12.00															10.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0154	011	0	1	01	01	H0154_011_0	7	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									0.00	0.00		0.00					.13	4.00		12.00															10.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									0.00	0.00		0.00					.13	4.00		12.00															10.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	01		100	1				30		90	1						90	30		31									3.16	95.00		285.00					3.16	95.00		285.00															237.50							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	4	3	Preferred Brand	1	4	000001	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					1.50	45.00		135.00															112.50							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.33	10.00		30.00					.33	10.00		30.00															25.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0248	001	0	1	04	01	H0248_001_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0248	001	0	1	04	01	H0248_001_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0248	001	0	1	04	01	H0248_001_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0248	001	0	1	04	01	H0248_001_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0248	001	0	1	04	01	H0248_001_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0248	001	0	1	04	01	H0248_001_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0248	001	0	1	04	01	H0248_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0248	001	0	1	04	01	H0248_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0248	001	0	1	04	01	H0248_001_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0248	001	0	1	04	01	H0248_001_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0281	001	0	1	48	05	H0281_001_0	8	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0281	001	0	1	48	05	H0281_001_0	8	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0281	001	0	1	48	05	H0281_001_0	8	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H0294	002	0	1	04	01	H0294_002_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.30	9.00		27.00																															18.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					478.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															20.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					861.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	101		1	30	60	90				1		60	90				30		31	.10	3.00	6.00	9.00																							6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	101		1	30	60	90				1		60	90				30		31	.43	13.00	26.00	39.00																							26.00	39.00																		13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	8	1	Preferred Generic	3	4	001000	1	2	111		01	101		1	30	60	90				1		60	90				30		31	.10	3.00	6.00	9.00																							6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	001	0	1	01	01	H0302_001_0	8	5	Specialty Tier	1	4	100101	1	1	010		01			1	30													30		31					346.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	101		1	30	60	90				1		60	90				30		31	3.00	90.00	180.00	270.00																							180.00	270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	101		1	30	60	90				1		60	90				30		31	1.33	40.00	80.00	120.00																							80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	101		1	30	60	90				1		60	90				30		31	3.16	95.00	190.00	285.00																							190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	8	5	Specialty Tier	1	4	100101	1	1	010		01			1	30													30		31					346.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	8	1	Preferred Generic	3	4	001000	1	2	111		01	101		1	30	60	90				1		60	90				30		31	0.13	4.00	8.00	12.00																							8.00	12.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	006	0	1	01	01	H0302_006_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	101		1	30	60	90				1		60	90				30		31	1.50	45.00	90.00	135.00																							90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	101		1	30	60	90				1		60	90				30		31	.46	14.00	28.00	42.00																							28.00	42.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	101		1	30	60	90				1		60	90				30		31	.13	4.00	8.00	12.00																							8.00	12.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	007	0	1	01	01	H0302_007_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	101		1	30	60	90				1		60	90				30		31	.06	2.00	4.00	6.00																							4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	007	0	1	01	01	H0302_007_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	101		1	30	60	90				1		60	90				30		31	.06	2.00	4.00	6.00																							4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	007	0	1	01	01	H0302_007_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	101		1	30	60	90				1		60	90				30		31	.40	12.00	24.00	36.00																							24.00	36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	007	0	1	01	01	H0302_007_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	101		1	30	60	90				1		60	90				30		31	1.00	30.00	60.00	90.00																							60.00	90.00																		30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	007	0	1	01	01	H0302_007_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	101		1	30	60	90				1		60	90				30		31	2.66	80.00	160.00	240.00																							160.00	240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	007	0	1	01	01	H0302_007_0	7	5	Specialty Tier	1	4	100101	1	1	010		01			1	30													30		31					346.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0303	013	0	1	01	01	H0303_013_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					666.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0303	013	0	1	01	01	H0303_013_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0303	013	0	1	01	01	H0303_013_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0303	013	0	1	01	01	H0303_013_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0303	013	0	1	01	01	H0303_013_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0303	015	0	1	01	01	H0303_015_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0303	015	0	1	01	01	H0303_015_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.30	9.00		27.00																															18.00							27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0303	015	0	1	01	01	H0303_015_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0303	015	0	1	01	01	H0303_015_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0303	015	0	1	01	01	H0303_015_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					639.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0316	002	0	1	02	01	H0316_002_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0316	002	0	1	02	01	H0316_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0316	002	0	1	02	01	H0316_002_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0316	002	0	1	02	01	H0316_002_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0316	002	0	1	02	01	H0316_002_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					537.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0316	014	0	1	01	01	H0316_014_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0316	014	0	1	01	01	H0316_014_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0316	014	0	1	01	01	H0316_014_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0316	014	0	1	01	01	H0316_014_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0316	014	0	1	01	01	H0316_014_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					623.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	001	0	1	04	01	H0317_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0317	001	0	1	04	01	H0317_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0317	001	0	1	04	01	H0317_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0317	001	0	1	04	01	H0317_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0317	001	0	1	04	01	H0317_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0317	001	0	1	04	01	H0317_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	001	0	1	04	01	H0317_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	001	0	1	04	01	H0317_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	001	0	1	04	01	H0317_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	001	0	1	04	01	H0317_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	004	0	1	04	01	H0317_004_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0317	004	0	1	04	01	H0317_004_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0317	004	0	1	04	01	H0317_004_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0317	004	0	1	04	01	H0317_004_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0317	004	0	1	04	01	H0317_004_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	004	0	1	04	01	H0317_004_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	004	0	1	04	01	H0317_004_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	004	0	1	04	01	H0317_004_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	004	0	1	04	01	H0317_004_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	004	0	1	04	01	H0317_004_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0317	006	0	1	04	01	H0317_006_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	006	0	1	04	01	H0317_006_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0317	006	0	1	04	01	H0317_006_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0317	006	0	1	04	01	H0317_006_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0317	006	0	1	04	01	H0317_006_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0317	006	0	1	04	01	H0317_006_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0317	006	0	1	04	01	H0317_006_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	006	0	1	04	01	H0317_006_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	006	0	1	04	01	H0317_006_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	006	0	1	04	01	H0317_006_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	007	0	1	04	01	H0317_007_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0317	007	0	1	04	01	H0317_007_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	007	0	1	04	01	H0317_007_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	007	0	1	04	01	H0317_007_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	007	0	1	04	01	H0317_007_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H0317	007	0	1	04	01	H0317_007_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0317	007	0	1	04	01	H0317_007_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	007	0	1	04	01	H0317_007_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0317	007	0	1	04	01	H0317_007_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0317	007	0	1	04	01	H0317_007_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0318	002	0	1	01	01	H0318_002_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0318	002	0	1	01	01	H0318_002_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0318	002	0	1	01	01	H0318_002_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0318	002	0	1	01	01	H0318_002_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					93.35	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0318	002	0	1	01	01	H0318_002_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					31.49	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0318	002	0	1	01	01	H0318_002_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0320	006	0	1	01	01	H0320_006_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.41	13.00	26.00	39.00					.64	20.00	40.00	60.00												.41	13.00	26.00	26.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	006	0	1	01	01	H0320_006_0	6	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.03	1.00	2.00	3.00					.16	5.00	10.00	15.00												.03	1.00	2.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	006	0	1	01	01	H0320_006_0	6	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	006	0	1	01	01	H0320_006_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.58	80.00	160.00	240.00					3.06	95.00	190.00	285.00												2.58	80.00	160.00	160.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	006	0	1	01	01	H0320_006_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	008	0	1	01	01	H0320_008_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.70	22.00	44.00	66.00												.48	15.00	30.00	30.00				.70	22.00	44.00	66.00				22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	008	0	1	01	01	H0320_008_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	008	0	1	01	01	H0320_008_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.96	30.00	60.00	90.00					1.29	40.00	80.00	120.00												.96	30.00	60.00	60.00				1.29	40.00	80.00	120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	008	0	1	01	01	H0320_008_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	008	0	1	01	01	H0320_008_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					2.41	75.00	150.00	225.00												1.93	60.00	120.00	120.00				2.41	75.00	150.00	225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	009	0	1	01	01	H0320_009_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	009	0	1	01	01	H0320_009_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.70	22.00	44.00	66.00												.48	15.00	30.00	30.00				.70	22.00	44.00	66.00				22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	009	0	1	01	01	H0320_009_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					2.41	75.00	150.00	225.00												1.93	60.00	120.00	120.00				2.41	75.00	150.00	225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	009	0	1	01	01	H0320_009_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.96	30.00	60.00	90.00					1.29	40.00	80.00	120.00												.96	30.00	60.00	60.00				1.29	40.00	80.00	120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0320	009	0	1	01	01	H0320_009_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	8	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		90	1							30		31									0.10	3.00		7.50					0.27	8.00		24.00																										8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		90	1							30		31									1.00	30.00		75.00					1.10	33.00		99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	8	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		90	1							30		31									0.10	3.00		7.50					0.27	8.00		24.00																										8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0332	002	0	1	01	01	H0332_002_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01			1				30		90	1							30		31									2.00	60.00		150.00					2.33	70.00		210.00																										70.00				2.26	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	8	5	Specialty Tier	1	4	100000	1	1		110	01			1				30		90	1							30		31													1.00	31		31					1.00	31		31																								31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	8	3	Preferred Brand	1	4	000001	1	2		110	01			1				30		90	1							30		31									1.33	40.00		100.00					1.50	45.00		135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	9	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		90	1							30		31									0.10	3.00		7.50					0.27	8.00		24.00																										8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		90	1							30		31									1.00	30.00		75.00					1.10	33.00		99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	9	3	Preferred Brand	1	4	000001	1	2		110	01			1				30		90	1							30		31									1.33	40.00		100.00					1.50	45.00		135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01			1				30		90	1							30		31									2.00	60.00		150.00					2.33	70.00		210.00																										70.00				2.26	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	9	5	Specialty Tier	1	4	100000	1	1		110	01			1				30		90	1							30		31													1.00	31		31					1.00	31		31																								31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	9	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		90	1							30		31									0.10	3.00		7.50					0.27	8.00		24.00																										8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0332	006	0	1	01	01	H0332_006_0	7	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		90	1							30		31									0.00	0.00		0.00					0.33	10.00		30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	006	0	1	01	01	H0332_006_0	7	5	Specialty Tier	1	4	100000	1	1		110	01			1				30		90	1							30		31													1.00	30		30					1.00	30		30																								30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	006	0	1	01	01	H0332_006_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01			1				30		90	1							30		31									1.67	50.00		150.00					2.00	60.00		180.00																										60.00				1.94	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	006	0	1	01	01	H0332_006_0	7	3	Preferred Brand	1	4	000001	1	2		110	01			1				30		90	1							30		31									0.67	20.00		60.00					1.00	30.00		90.00																										30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	006	0	1	01	01	H0332_006_0	7	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		90	1							30		31									0.00	0.00		0.00					0.33	10.00		30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0332	006	0	1	01	01	H0332_006_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		90	1							30		31									0.67	20.00		60.00					1.00	30.00		90.00																										30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0336	001	0	1	48	05	H0336_001_0	8	4	Non-Medicare OTC Drugs	1	4	010010			110		01	110		1	30		90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0336	001	0	1	48	05	H0336_001_0	8	3	Non-Medicare Rx Drugs	1	4	010010			110		01	110		1	30		90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0336	001	0	1	48	05	H0336_001_0	8	2	Brand Drugs	1	4	000010			110		01	110		1	30		90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1											
H0336	001	0	1	48	05	H0336_001_0	8	1	Generic Drugs	1	4	010000			110		01	110		1	30		90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1											
H0351	029	0	1	01	01	H0351_029_0	6	4	Non-Preferred Brand	1	2	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	6	5	Specialty Tier	1	2	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					273.98	25	25	25																												25	25	25					25	25	25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	6	3	Preferred Brand	1	2	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.36	41.00	82.00	123.00																												1.36	41.00	82.00	113.00				1.36	41.00	82.00	123.00				41.00				1.20	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	6	2	Non-Preferred Generic	1	2	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.40	12.00	24.00	36.00																												0.40	12.00	24.00	24.00				0.40	12.00	24.00	36.00				12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	6	1	Preferred Generic	1	2	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	6	6	Select Care Drugs	1	2	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	035	0	1	01	01	H0351_035_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	035	0	1	01	01	H0351_035_0	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.10	3.00	6.00	9.00																												0.10	3.00	6.00	6.00				0.10	3.00	6.00	9.00				3.00				0.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	035	0	1	01	01	H0351_035_0	5	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	035	0	1	01	01	H0351_035_0	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	035	0	1	01	01	H0351_035_0	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					389.53	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	035	0	1	01	01	H0351_035_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	036	0	1	01	01	H0351_036_0	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.10	3.00	6.00	9.00																												0.10	3.00	6.00	6.00				0.10	3.00	6.00	9.00				3.00				0.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	036	0	1	01	01	H0351_036_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	036	0	1	01	01	H0351_036_0	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					346.56	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	036	0	1	01	01	H0351_036_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	036	0	1	01	01	H0351_036_0	5	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	036	0	1	01	01	H0351_036_0	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					489.86	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.46	44.00	88.00	132.00																												1.46	44.00	88.00	122.00				1.46	44.00	88.00	132.00				44.00				1.29	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	040	0	1	01	01	H0351_040_0	7	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					421.58	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	040	0	1	01	01	H0351_040_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	040	0	1	01	01	H0351_040_0	7	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.46	44.00	88.00	132.00																												1.46	44.00	88.00	122.00				1.46	44.00	88.00	132.00				44.00				1.29	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	040	0	1	01	01	H0351_040_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	040	0	1	01	01	H0351_040_0	7	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	040	0	1	01	01	H0351_040_0	7	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_0	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					400.04	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_0	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.46	44.00	88.00	132.00																												1.46	44.00	88.00	122.00				1.46	44.00	88.00	132.00				44.00				1.29	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.40	12.00	24.00	36.00																												0.40	12.00	24.00	24.00				0.40	12.00	24.00	36.00				12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_0	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_0	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.46	44.00	88.00	132.00																												1.46	44.00	88.00	122.00				1.46	44.00	88.00	132.00				44.00				1.29	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					354.58	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.10	3.00	6.00	9.00																												0.10	3.00	6.00	6.00				0.10	3.00	6.00	9.00				3.00				0.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					414.76	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	2	1	01	01	H0351_043_2	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	2	1	01	01	H0351_043_2	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	2	1	01	01	H0351_043_2	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					414.76	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	2	1	01	01	H0351_043_2	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	2	1	01	01	H0351_043_2	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.10	3.00	6.00	9.00																												0.10	3.00	6.00	6.00				0.10	3.00	6.00	9.00				3.00				0.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	2	1	01	01	H0351_043_2	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.10	3.00	6.00	9.00																												0.10	3.00	6.00	6.00				0.10	3.00	6.00	9.00				3.00				0.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					414.76	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0354	001	0	1	01	01	H0354_001_0	9	1	Preferred Generic	1	4	001001	1	2		111	01	110		1				30	60	90	1	30		90				30		31									.10	3.00	6.00	9.00					.33	10.00	20.00	30.00					.10	3.00		6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	9	2	Non-Preferred Generic	3	4	000101	1	2		111	01	110		1				30	60	90	1	30		90				30		31									.33	10.00	20.00	30.00					.56	17.00	34.00	51.00					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0354	001	0	1	01	01	H0354_001_0	9	1	Preferred Generic	3	4	001001	1	2		111	01	110		1				30	60	90	1	30		90				30		31									.10	3.00	6.00	9.00					.33	10.00	20.00	30.00					.10	3.00		6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0354	001	0	1	01	01	H0354_001_0	9	5	Specialty Tier	1	4	010010	1	1		111	01	110		1				30	60	90	1	30		90				30		31													1.00	33	33	33					1.00	33	33	33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	110		1				30	60	90	1	30		90				30		31									2.50	75.00	150.00	225.00					3.16	95.00	190.00	285.00					2.50	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	110		1				30	60	90	1	30		90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00		80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	9	2	Non-Preferred Generic	1	4	000101	1	2		111	01	110		1				30	60	90	1	30		90				30		31									.33	10.00	20.00	30.00					.56	17.00	34.00	51.00					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	021	0	1	01	01	H0354_021_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	110		1				30	60	90	1	30		90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00		80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	021	0	1	01	01	H0354_021_0	7	2	Non-Preferred Generic	1	4	000101	1	2		111	01	110		1				30	60	90	1	30		90				30		31									.30	9.00	18.00	27.00					.53	16.00	32.00	48.00					.30	9.00		18.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	021	0	1	01	01	H0354_021_0	7	1	Preferred Generic	1	4	001001	1	2		111	01	110		1				30	60	90	1	30		90				30		31									.06	2.00	4.00	6.00					.30	9.00	18.00	27.00					.06	2.00		4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	021	0	1	01	01	H0354_021_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	110		1				30	60	90	1	30		90				30		31									2.50	75.00	150.00	225.00					3.16	95.00	190.00	285.00					2.50	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	021	0	1	01	01	H0354_021_0	7	2	Non-Preferred Generic	3	4	000101	1	2		111	01	110		1				30	60	90	1	30		90				30		31									.30	9.00	18.00	27.00					.53	16.00	32.00	48.00					.30	9.00		18.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0354	021	0	1	01	01	H0354_021_0	7	1	Preferred Generic	3	4	001001	1	2		111	01	110		1				30	60	90	1	30		90				30		31									.06	2.00	4.00	6.00					.30	9.00	18.00	27.00					.06	2.00		4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0354	021	0	1	01	01	H0354_021_0	7	5	Specialty Tier	1	4	010010	1	1		111	01	110		1				30	60	90	1	30		90				30		31													1.00	33	33	33					1.00	33	33	33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	002	0	1	01	01	H0435_002_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.13	4.00	8.00	10.00																					0.13	4.00	8.00	10.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H0435	002	0	1	01	01	H0435_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.32	10.00	20.00	25.00																					0.32	10.00	20.00	25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H0435	002	0	1	01	01	H0435_002_0	7	4	Specialty Tier	1	4	100000	1	1	010		01	010		1	30							30						30		31					787.60	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H0435	002	0	1	01	01	H0435_002_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.29	40.00	80.00	100.00																					1.29	40.00	80.00	100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H0435	003	0	1	01	01	H0435_003_0	7	4	Specialty Tier	1	4	100000	1	1	010		01	010		1	30							30						30		31					787.60	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H0435	003	0	1	01	01	H0435_003_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.29	40.00	80.00	100.00																					1.29	40.00	80.00	100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H0435	003	0	1	01	01	H0435_003_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.32	10.00	20.00	25.00																					0.32	10.00	20.00	25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H0435	003	0	1	01	01	H0435_003_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.13	4.00	8.00	10.00																					0.13	4.00	8.00	10.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H0439	001	0	1	01	01	H0439_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00		245.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0439	001	0	1	01	01	H0439_001_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0439	001	0	1	01	01	H0439_001_0	6	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0439	001	0	1	01	01	H0439_001_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					595.29	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0439	001	0	1	01	01	H0439_001_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0439	001	0	1	01	01	H0439_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0439	001	0	1	01	01	H0439_001_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0490	004	0	1	01	01	H0490_004_0	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31						25																							25																			25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0490	004	0	1	01	01	H0490_004_0	10	3	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0490	004	0	1	01	01	H0490_004_0	10	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0490	004	0	1	01	01	H0490_004_0	10	1	Generic	1	4	010000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	7	2	Non-Preferred Generic	1	4	001100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	7	3	Preferred Brand	1	4	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		90.00					1.50	45.00		135.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	7	4	Non-Preferred Brand	1	4	100100	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		170.00					2.83	85.00		255.00								170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	7	5	Injectable Drugs	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													162.00	25		25					162.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	7	6	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1475.00	33		33					1475.00	33		33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_0	7	2	Non-Preferred Generic	3	4	001100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	017	0	1	01	01	H0504_017_0	7	2	Preferred Brand	1	4	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		90.00					1.50	45.00		135.00								90.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	7	3	Non-Preferred Brand	1	4	100100	1	2		110	01	100		1				30		90	1			90				30		31									3.00	90.00		180.00					3.00	90.00		270.00								180.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	017	0	1	01	01	H0504_017_0	7	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1901.00	33		33					1901.00	33		33							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	7	4	Injectable Drugs	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													153.00	25		25					153.00	25		25							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7	2	Preferred Brand	1	4	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		70.00					1.16	35.00		105.00								70.00																		35.00				1.12	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7	3	Non-Preferred Brand	1	4	100100	1	2		110	01	100		1				30		90	1			90				30		31									2.33	70.00		140.00					2.33	70.00		210.00								140.00																		70.00				2.25	70.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7	1	Preferred Generic	3	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	021	0	1	01	01	H0504_021_0	7	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1475.00	33		33					1475.00	33		33							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7	4	Injectable Drugs	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													216.00	25		25					216.00	25		25							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7	2	Preferred Brand	3	4	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		70.00					1.16	35.00		105.00								70.00																		35.00				1.12	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	2	
H0504	026	0	1	01	01	H0504_026_0	7	3	Non-Preferred Brand	1	4	100100	1	2		110	01	100		1				30		90	1			90				30		31									3.00	90.00		180.00					3.00	90.00		270.00								180.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	7	2	Preferred Brand	1	4	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		90.00					1.50	45.00		135.00								90.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	7	4	Injectable Drugs	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													175.00	25		25					175.00	25		25							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	026	0	1	01	01	H0504_026_0	7	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													739.00	33		33					739.00	33		33							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	027	0	1	01	01	H0504_027_0	7	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1467.00	33		33					1467.00	33		33							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	027	0	1	01	01	H0504_027_0	7	4	Injectable Drugs	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													165.00	25		25					165.00	25		25							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	027	0	1	01	01	H0504_027_0	7	3	Non-Preferred Brand	1	4	100100	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		170.00					2.83	85.00		255.00								170.00																		85.00				2.74	85.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	027	0	1	01	01	H0504_027_0	7	2	Preferred Brand	1	4	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		90.00					1.50	45.00		135.00								90.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	027	0	1	01	01	H0504_027_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	6	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1467.00	33		33					1467.00	33		33							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	6	4	Injectable Drugs	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													165.00	25		25					165.00	25		25							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	6	3	Non-Preferred Brand	1	4	100100	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		170.00					2.83	85.00		255.00								170.00																		85.00				2.74	85.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	6	2	Preferred Brand	1	4	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		90.00					1.50	45.00		135.00								90.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	028	0	1	01	01	H0504_028_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	029	0	1	01	01	H0504_029_0	6	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1467.00	33		33					1467.00	33		33							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	6	4	Injectable Drugs	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													165.00	25		25					165.00	25		25							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	6	3	Non-Preferred Brand	1	4	100100	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		170.00					2.83	85.00		255.00								170.00																		85.00				2.74	85.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	6	2	Preferred Brand	1	4	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		90.00					1.50	45.00		135.00								90.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	030	0	1	01	01	H0504_030_0	7	4	Injectable Drugs	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													165.00	25		25					165.00	25		25							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	030	0	1	01	01	H0504_030_0	7	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1467.00	33		33					1467.00	33		33							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	030	0	1	01	01	H0504_030_0	7	3	Non-Preferred Brand	1	4	100100	1	2		110	01	100		1				30		90	1			90				30		31									3.00	90.00		180.00					3.00	90.00		270.00								180.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	030	0	1	01	01	H0504_030_0	7	2	Preferred Brand	1	4	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		90.00					1.50	45.00		135.00								90.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	030	0	1	01	01	H0504_030_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	030	0	1	01	01	H0504_030_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	031	0	1	01	01	H0504_031_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	7	2	Preferred Brand	1	4	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		90.00					1.50	45.00		135.00								90.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	7	3	Non-Preferred Brand	1	4	100100	1	2		110	01	100		1				30		90	1			90				30		31									3.00	90.00		180.00					3.00	90.00		270.00								180.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	7	4	Injectable Drugs	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													165.00	25		25					165.00	25		25							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	7	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1467.00	33		33					1467.00	33		33							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	032	0	1	01	01	H0504_032_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	7	2	Preferred Brand	1	4	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		90.00					1.50	45.00		135.00								90.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	7	3	Non-Preferred Brand	1	4	100100	1	2		110	01	100		1				30		90	1			90				30		31									3.00	90.00		180.00					3.00	90.00		270.00								180.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	7	4	Injectable Drugs	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													165.00	25		25					165.00	25		25							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	7	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1467.00	33		33					1467.00	33		33							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0523	002	0	1	01	01	H0523_002_0	6	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0523	002	0	1	01	01	H0523_002_0	6	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	002	0	1	01	01	H0523_002_0	6	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	002	0	1	01	01	H0523_002_0	6	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					76.71	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	002	0	1	01	01	H0523_002_0	6	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					35.98	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	002	0	1	01	01	H0523_002_0	6	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	022	0	1	01	01	H0523_022_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	022	0	1	01	01	H0523_022_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0523	022	0	1	01	01	H0523_022_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	022	0	1	01	01	H0523_022_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	022	0	1	01	01	H0523_022_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					72.31	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	022	0	1	01	01	H0523_022_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.54	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	031	0	1	01	01	H0523_031_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	031	0	1	01	01	H0523_031_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	031	0	1	01	01	H0523_031_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					68.94	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	031	0	1	01	01	H0523_031_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					35.36	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	031	0	1	01	01	H0523_031_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0523	031	0	1	01	01	H0523_031_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	032	0	1	01	01	H0523_032_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0523	032	0	1	01	01	H0523_032_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	032	0	1	01	01	H0523_032_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	032	0	1	01	01	H0523_032_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					35.70	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	032	0	1	01	01	H0523_032_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					77.68	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	032	0	1	01	01	H0523_032_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	052	0	1	01	01	H0523_052_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	052	0	1	01	01	H0523_052_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.49	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	052	0	1	01	01	H0523_052_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.04	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	052	0	1	01	01	H0523_052_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	052	0	1	01	01	H0523_052_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	052	0	1	01	01	H0523_052_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0523	060	0	1	01	01	H0523_060_0	6	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	060	0	1	01	01	H0523_060_0	6	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					35.25	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	060	0	1	01	01	H0523_060_0	6	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					80.21	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	060	0	1	01	01	H0523_060_0	6	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	060	0	1	01	01	H0523_060_0	6	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.16	5.00	10.00	15.00					5.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0523	060	0	1	01	01	H0523_060_0	6	1	Generic	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0523	060	0	1	01	01	H0523_060_0	6	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.16	5.00	10.00	15.00					5.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0524	002	0	2	01	01	H0524_002_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	002	0	2	01	01	H0524_002_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	002	0	2	01	01	H0524_002_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					607.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.40	12.00		36.00																					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.40	12.00		36.00																					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.10	3.00		9.00																					.10	3.00		6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.10	3.00		9.00																					.10	3.00		6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					581.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	008	0	1	01	01	H0524_008_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	008	0	1	01	01	H0524_008_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					626.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	7	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					616.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	7	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	7	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					620.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.40	12.00		36.00																					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.40	12.00		36.00																					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					620.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.23	7.00		21.00																					.23	7.00		14.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.40	12.00		36.00																					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	6	Vaccines	1	3	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					629.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	030	0	1	01	01	H0524_030_0	7	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.26	8.00		24.00																					.26	8.00		16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	030	0	1	01	01	H0524_030_0	7	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.43	13.00		39.00																					.43	13.00		26.00																		13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	030	0	1	01	01	H0524_030_0	7	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	030	0	1	01	01	H0524_030_0	7	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	030	0	1	01	01	H0524_030_0	7	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					543.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	030	0	1	01	01	H0524_030_0	7	6	Vaccines	1	3	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					713.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					519.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					659.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	033	0	1	01	01	H0524_033_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	033	0	1	01	01	H0524_033_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.40	12.00		36.00																					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.40	12.00		36.00																					.38	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					642.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.40	12.00		36.00																					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					701.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	035	0	1	01	01	H0524_035_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.40	12.00		36.00																					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	035	0	1	01	01	H0524_035_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	035	0	1	01	01	H0524_035_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	0.40	12.00		36.00																					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.40	12.00		36.00																					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					973.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.40	12.00		36.00																					.40	12.00		24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					655.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.40	12.00		36.00																					.40	12.00		24.00																		12.00				.40	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					744.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	3	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	3	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	039	0	1	01	01	H0524_039_0	3	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	039	0	1	01	01	H0524_039_0	3	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	3	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	039	0	1	01	01	H0524_039_0	3	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	3	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	3	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	3	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					689.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	6	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	6	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					552.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	6	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	6	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					546.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					782.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	042	0	1	01	01	H0524_042_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	042	0	1	01	01	H0524_042_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	042	0	1	01	01	H0524_042_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	4	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	4	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	4	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					624.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	4	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31					507.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	4	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	046	0	1	01	01	H0524_046_0	4	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	046	0	1	01	01	H0524_046_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0543	001	0	1	01	01	H0543_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					607.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	001	0	1	01	01	H0543_001_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	004	0	1	01	01	H0543_004_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	004	0	1	01	01	H0543_004_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	004	0	1	01	01	H0543_004_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	004	0	1	01	01	H0543_004_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	004	0	1	01	01	H0543_004_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					544.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	007	0	1	01	01	H0543_007_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	007	0	1	01	01	H0543_007_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					627.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					534.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	013	0	1	01	01	H0543_013_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	019	0	1	01	01	H0543_019_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					715.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					627.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					742.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.30	9.00		27.00																															18.00							27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					546.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					481.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					818.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.30	9.00		27.00																															18.00							27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					581.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					519.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.40	42.00		126.00																															116.00							126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	060	0	1	01	01	H0543_060_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	070	0	1	01	01	H0543_070_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.33	10.00		30.00																															20.00							30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					477.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.36	11.00		33.00																															22.00							33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					723.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					602.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.23	7.00		21.00																															14.00							21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					601.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	6	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	138	0	1	01	01	H0543_138_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.23	7.00		21.00																															14.00							21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	140	0	1	01	01	H0543_140_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					678.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.23	7.00		21.00																															14.00							21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	144	0	1	01	01	H0543_144_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	144	0	1	01	01	H0543_144_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.23	7.00		21.00																															14.00							21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					532.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					548.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	145	0	1	01	01	H0543_145_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	146	0	1	01	01	H0543_146_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.30	9.00		27.00																															18.00							27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					613.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					562.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.30	9.00		27.00																															18.00							27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.30	9.00		27.00																															18.00							27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					586.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	149	0	1	01	01	H0543_149_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	149	0	1	01	01	H0543_149_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	149	0	1	01	01	H0543_149_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	149	0	1	01	01	H0543_149_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					495.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	149	0	1	01	01	H0543_149_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.23	7.00		21.00																															14.00							21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	151	0	1	01	01	H0543_151_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					605.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.23	7.00		21.00																															14.00							21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	152	0	1	01	01	H0543_152_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.30	9.00		27.00																															18.00							27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					536.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	152	0	1	01	01	H0543_152_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.30	9.00		27.00																															18.00							27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	152	0	1	01	01	H0543_152_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0544	002	0	1	01	01	H0544_002_0	10	6	Select Care Drugs	3	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.96	30.00		90.00																								75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.74	85.00		255.00																								212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					428.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_0	10	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.96	30.00		90.00																								75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	002	0	1	01	01	H0544_002_0	10	4	Non-Preferred Brand	3	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.74	85.00		255.00																								212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	002	0	1	01	01	H0544_002_0	10	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	8	6	Select Care Drugs	3	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_003_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_003_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_003_0	8	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					3.30	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	8	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					3.09	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	8	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				1			90				30		31					4.12	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	4	Non-Preferred Brand	3	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.74	85.00		255.00																								212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	004	0	1	01	01	H0544_004_0	9	6	Select Care Drugs	3	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.96	30.00		90.00																								75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	004	0	1	01	01	H0544_004_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					428.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.74	85.00		255.00																								212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.96	30.00		90.00																								75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.96	30.00		90.00																								75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.74	85.00		255.00																								212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					428.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	8	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_0	8	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.96	30.00		90.00																								75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	005	0	1	01	01	H0544_005_0	8	4	Non-Preferred Brand	3	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.74	85.00		255.00																								212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	005	0	1	01	01	H0544_005_0	8	6	Select Care Drugs	3	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	007	0	1	01	01	H0544_007_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.32	10.00		30.00																								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	9	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.32	10.00		30.00																								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					428.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	008	0	1	01	01	H0544_008_0	10	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	008	0	1	01	01	H0544_008_0	10	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	10	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	008	0	1	01	01	H0544_008_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	10	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	10	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	010	0	1	01	01	H0544_010_0	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	10	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	010	0	1	01	01	H0544_010_0	10	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	010	0	1	01	01	H0544_010_0	10	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	10	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	010	0	1	01	01	H0544_010_0	10	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	012	0	1	01	01	H0544_012_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	012	0	1	01	01	H0544_012_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	012	0	1	01	01	H0544_012_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	9	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	012	0	1	01	01	H0544_012_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	9	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_0	9	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.96	30.00		90.00																								75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	013	0	1	01	01	H0544_013_0	9	4	Non-Preferred Brand	3	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.74	85.00		255.00																								212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	013	0	1	01	01	H0544_013_0	9	6	Select Care Drugs	3	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					428.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.74	85.00		255.00																								212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.96	30.00		90.00																								75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	9	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	9	6	Select Care Drugs	3	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	9	4	Non-Preferred Brand	3	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.74	85.00		255.00																								212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	014	0	1	01	01	H0544_014_0	9	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.96	30.00		90.00																								75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	014	0	1	01	01	H0544_014_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	9	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					428.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.74	85.00		255.00																								212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.96	30.00		90.00																								75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	10	4	Non-Preferred Brand	3	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.74	85.00		255.00																								212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	015	0	1	01	01	H0544_015_0	10	6	Select Care Drugs	3	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.96	30.00		90.00																								75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	10	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.96	30.00		90.00																								75.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	015	0	1	01	01	H0544_015_0	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					428.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	10	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.74	85.00		255.00																								212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	10	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	019	0	1	01	01	H0544_019_0	10	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	019	0	1	01	01	H0544_019_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	10	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	10	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	10	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_0	10	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	020	0	1	01	01	H0544_020_0	9	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	020	0	1	01	01	H0544_020_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	9	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	020	0	1	01	01	H0544_020_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	020	0	1	01	01	H0544_020_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	020	0	1	01	01	H0544_020_0	9	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	9	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	020	0	1	01	01	H0544_020_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.29	40.00		120.00					1.45	45.00		135.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.25	8.00		24.00					0.41	13.00		39.00								20.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.90	90.00		270.00					3.06	95.00		285.00								225.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	9	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.32	10.00		30.00					0.32	10.00		30.00								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	9	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	024	0	1	01	01	H0544_024_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	024	0	1	01	01	H0544_024_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	024	0	1	01	01	H0544_024_0	9	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	9	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	024	0	1	01	01	H0544_024_0	9	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	025	0	1	01	01	H0544_025_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	8	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	025	0	1	01	01	H0544_025_0	8	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	025	0	1	01	01	H0544_025_0	8	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	025	0	1	01	01	H0544_025_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	025	0	1	01	01	H0544_025_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	8	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	027	0	1	01	01	H0544_027_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	027	0	1	01	01	H0544_027_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	027	0	1	01	01	H0544_027_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	9	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	027	0	1	01	01	H0544_027_0	9	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	9	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	031	0	1	01	01	H0544_031_0	9	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	031	0	1	01	01	H0544_031_0	9	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	031	0	1	01	01	H0544_031_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	031	0	1	01	01	H0544_031_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	031	0	1	01	01	H0544_031_0	9	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	9	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	032	0	1	01	01	H0544_032_0	9	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	032	0	1	01	01	H0544_032_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	032	0	1	01	01	H0544_032_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	032	0	1	01	01	H0544_032_0	9	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	032	0	1	01	01	H0544_032_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	9	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	9	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	036	0	1	01	01	H0544_036_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	036	0	1	01	01	H0544_036_0	9	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	036	0	1	01	01	H0544_036_0	9	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	036	0	1	01	01	H0544_036_0	9	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	037	0	1	01	01	H0544_037_0	11	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	11	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	11	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	11	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	037	0	1	01	01	H0544_037_0	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	11	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	037	0	1	01	01	H0544_037_0	11	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	037	0	1	01	01	H0544_037_0	11	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	037	0	1	01	01	H0544_037_0	11	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	11	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	038	0	1	01	01	H0544_038_0	11	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	038	0	1	01	01	H0544_038_0	11	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	038	0	1	01	01	H0544_038_0	11	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H0544	038	0	1	01	01	H0544_038_0	11	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	038	0	1	01	01	H0544_038_0	11	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	038	0	1	01	01	H0544_038_0	11	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	11	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	11	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	11	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	12	6	Select Care Drugs	3	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	041	0	1	01	01	H0544_041_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	12	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	041	0	1	01	01	H0544_041_0	12	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	041	0	1	01	01	H0544_041_0	12	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	12	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					3.30	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	12	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					3.09	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	12	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				1			90				30		31					4.12	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0545	001	0	1	01	01	H0545_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	001	0	1	01	01	H0545_001_0	6	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				2			90				30		31	.50	15.00		45.00																								30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	001	0	1	01	01	H0545_001_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.30	39.00		117.00																								78.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	001	0	1	01	01	H0545_001_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				2			90				30		31	2.63	79.00		237.00																								158.00																		79.00				2.54	79.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	001	0	1	01	01	H0545_001_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					844.12	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	001	0	1	01	01	H0545_001_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0545	011	0	1	01	01	H0545_011_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.26	8.00		24.00																								24.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	011	0	1	01	01	H0545_011_0	5	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				2			90				30		31	.50	15.00		45.00																								45.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	011	0	1	01	01	H0545_011_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	011	0	1	01	01	H0545_011_0	5	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				2			90				30		31	2.63	79.00		237.00																								237.00																		79.00				2.54	79.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	011	0	1	01	01	H0545_011_0	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					850.62	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	012	0	1	01	01	H0545_012_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	012	0	1	01	01	H0545_012_0	8	2	Non-Preferred Generic	3	4	000100	3	2	110		01	100		1	31		90				1			90				31		31	0.09	3.00		9.00																								9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0545	012	0	1	01	01	H0545_012_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0545	012	0	1	01	01	H0545_012_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					474.00	30																							30																			30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	012	0	1	01	01	H0545_012_0	8	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	31		90				2			90				31		31	1.29	40.00		120.00																								120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	012	0	1	01	01	H0545_012_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	0.80	25.00		75.00																								75.00																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	012	0	1	01	01	H0545_012_0	8	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	31		90				1			90				31		31	0.09	3.00		9.00																								9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	5	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				2			90				30		31	.50	15.00		45.00																								30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.30	39.00		117.00																								78.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	5	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				2			90				30		31	2.96	89.00		267.00																								178.00																		89.00				2.87	89.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					844.12	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0562	009	0	1	01	01	H0562_009_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					389.85	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	4	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.40	12.00	24.00	36.00																												0.40	12.00	24.00	24.00				0.40	12.00	24.00	36.00				12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00				3.00				0.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.33	10.00	20.00	30.00																												0.33	10.00	20.00	20.00				0.33	10.00	20.00	30.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					375.14	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.10	3.00	6.00	9.00																												0.10	3.00	6.00	6.00				0.10	3.00	6.00	9.00				3.00				0.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	012	0	1	01	01	H0562_012_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00				3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	6	Select Care Drugs	3	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	012	0	1	01	01	H0562_012_0	4	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	20.00				0.33	10.00	20.00	30.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	039	0	1	01	01	H0562_039_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					280.50	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.40	12.00	24.00	36.00																												.40	12.00	24.00	24.00				.40	12.00	24.00	36.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00				3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	040	0	1	01	01	H0562_040_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	040	0	1	01	01	H0562_040_0	3	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	040	0	1	01	01	H0562_040_0	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.16	5.00	10.00	15.00																												0.16	5.00	10.00	10.00				0.16	5.00	10.00	15.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	040	0	1	01	01	H0562_040_0	3	6	Select Care Drugs	3	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	040	0	1	01	01	H0562_040_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	040	0	1	01	01	H0562_040_0	3	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.16	5.00	10.00	15.00																												0.16	5.00	10.00	10.00				0.16	5.00	10.00	15.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	040	0	1	01	01	H0562_040_0	3	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	040	0	1	01	01	H0562_040_0	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					279.25	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	040	0	1	01	01	H0562_040_0	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	053	0	1	01	01	H0562_053_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	053	0	1	01	01	H0562_053_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	053	0	1	01	01	H0562_053_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					357.69	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	053	0	1	01	01	H0562_053_0	4	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	053	0	1	01	01	H0562_053_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.40	12.00	24.00	36.00																												.40	12.00	24.00	24.00				.40	12.00	24.00	36.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	053	0	1	01	01	H0562_053_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00				3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	4	5	Specialty Tier	1	2	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					330.99	25	25	25																												25	25	25					25	25	25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	4	6	Select Care Drugs	1	2	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	4	3	Preferred Brand	1	2	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.36	41.00	82.00	123.00																												1.36	41.00	82.00	113.00				1.36	41.00	82.00	123.00				41.00				1.20	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.40	12.00	24.00	36.00																												.40	12.00	24.00	24.00				.40	12.00	24.00	36.00				12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	4	1	Preferred Generic	1	2	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					355.85	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	4	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.40	12.00	24.00	36.00																												0.40	12.00	24.00	24.00				0.40	12.00	24.00	36.00				12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.10	3.00	6.00	9.00																												0.10	3.00	6.00	6.00				0.10	3.00	6.00	9.00				3.00				0.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	070	0	1	01	01	H0562_070_0	5	2	Non-Preferred Generic	1	2	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.43	13.00	26.00	39.00																												.43	13.00	26.00	26.00				.43	13.00	26.00	39.00				13.00				.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	070	0	1	01	01	H0562_070_0	5	1	Preferred Generic	1	2	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	070	0	1	01	01	H0562_070_0	5	3	Preferred Brand	1	2	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	070	0	1	01	01	H0562_070_0	5	4	Non-Preferred Brand	1	2	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	070	0	1	01	01	H0562_070_0	5	5	Specialty Tier	1	2	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					288.65	25	25	25																												25	25	25					25	25	25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	070	0	1	01	01	H0562_070_0	5	6	Select Care Drugs	1	2	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					360.44	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		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	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		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	6	Select Care Drugs	3	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	084	0	1	01	01	H0562_084_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.40	12.00	24.00	36.00																												.40	12.00	24.00	24.00				.40	12.00	24.00	36.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00				3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					443.77	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	087	0	1	01	01	H0562_087_0	4	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	087	0	1	01	01	H0562_087_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	087	0	1	01	01	H0562_087_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					282.56	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	087	0	1	01	01	H0562_087_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	087	0	1	01	01	H0562_087_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.50	15.00	30.00	45.00																												.50	15.00	30.00	30.00				.50	15.00	30.00	45.00				15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	087	0	1	01	01	H0562_087_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00				3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	089	0	1	01	01	H0562_089_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	089	0	1	01	01	H0562_089_0	4	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	089	0	1	01	01	H0562_089_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	089	0	1	01	01	H0562_089_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.10	3.00	6.00	9.00																												0.10	3.00	6.00	6.00				0.10	3.00	6.00	9.00				3.00				0.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	089	0	1	01	01	H0562_089_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					365.42	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	089	0	1	01	01	H0562_089_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	3	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					387.26	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	3	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00				3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	091	0	1	01	01	H0562_091_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	091	0	1	01	01	H0562_091_0	4	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	091	0	1	01	01	H0562_091_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	091	0	1	01	01	H0562_091_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	091	0	1	01	01	H0562_091_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.16	5.00	10.00	15.00																												0.16	5.00	10.00	10.00				0.16	5.00	10.00	15.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	091	0	1	01	01	H0562_091_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					384.72	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	3	6	Select Care Drugs	3	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	092	0	1	01	01	H0562_092_0	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	3	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					394.58	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	3	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	3	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	092	0	1	01	01	H0562_092_0	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	093	0	1	01	01	H0562_093_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.10	3.00	6.00	9.00																												0.10	3.00	6.00	6.00				0.10	3.00	6.00	9.00				3.00				0.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	093	0	1	01	01	H0562_093_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	20.00				0.33	10.00	20.00	30.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	093	0	1	01	01	H0562_093_0	4	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	093	0	1	01	01	H0562_093_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	093	0	1	01	01	H0562_093_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					302.98	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	093	0	1	01	01	H0562_093_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	094	0	1	01	01	H0562_094_0	3	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	094	0	1	01	01	H0562_094_0	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.26	8.00	16.00	24.00																												0.26	8.00	16.00	16.00				0.26	8.00	16.00	24.00				8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	094	0	1	01	01	H0562_094_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.60	18.00	36.00	54.00																												0.60	18.00	36.00	36.00				0.60	18.00	36.00	54.00				18.00				0.52	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	094	0	1	01	01	H0562_094_0	3	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	094	0	1	01	01	H0562_094_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	094	0	1	01	01	H0562_094_0	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					270.00	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	095	0	1	01	01	H0562_095_0	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.26	8.00	16.00	24.00																												0.26	8.00	16.00	16.00				0.26	8.00	16.00	24.00				8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	095	0	1	01	01	H0562_095_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.60	18.00	36.00	54.00																												0.60	18.00	36.00	36.00				0.60	18.00	36.00	54.00				18.00				0.52	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	095	0	1	01	01	H0562_095_0	3	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	095	0	1	01	01	H0562_095_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	095	0	1	01	01	H0562_095_0	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					270.00	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	095	0	1	01	01	H0562_095_0	3	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	096	0	1	01	01	H0562_096_0	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.26	8.00	16.00	24.00																												0.26	8.00	16.00	16.00				0.26	8.00	16.00	24.00				8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	096	0	1	01	01	H0562_096_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.60	18.00	36.00	54.00																												0.60	18.00	36.00	36.00				0.60	18.00	36.00	54.00				18.00				0.52	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	096	0	1	01	01	H0562_096_0	3	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	096	0	1	01	01	H0562_096_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	096	0	1	01	01	H0562_096_0	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					270.00	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	096	0	1	01	01	H0562_096_0	3	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.16	5.00	10.00	15.00																												0.16	5.00	10.00	10.00				0.16	5.00	10.00	15.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					406.11	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	098	1	1	01	01	H0562_098_1	3	6	Select Care Drugs	1	3	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	098	1	1	01	01	H0562_098_1	3	5	Specialty Tier	1	3	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					472.00	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	098	1	1	01	01	H0562_098_1	3	4	Non-Preferred Brand	1	3	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	098	1	1	01	01	H0562_098_1	3	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	098	1	1	01	01	H0562_098_1	3	1	Preferred Generic	1	3	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.26	8.00	16.00	24.00																												0.26	8.00	16.00	16.00				0.26	8.00	16.00	24.00				8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	098	1	1	01	01	H0562_098_1	3	2	Non-Preferred Generic	1	3	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.60	18.00	36.00	54.00																												0.60	18.00	36.00	36.00				0.60	18.00	36.00	54.00				18.00				0.52	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	098	2	1	01	01	H0562_098_2	3	1	Preferred Generic	1	3	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.26	8.00	16.00	24.00																												0.26	8.00	16.00	16.00				0.26	8.00	16.00	24.00				8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	098	2	1	01	01	H0562_098_2	3	2	Non-Preferred Generic	1	3	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.60	18.00	36.00	54.00																												0.60	18.00	36.00	36.00				0.60	18.00	36.00	54.00				18.00				0.52	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	098	2	1	01	01	H0562_098_2	3	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	098	2	1	01	01	H0562_098_2	3	4	Non-Preferred Brand	1	3	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	098	2	1	01	01	H0562_098_2	3	5	Specialty Tier	1	3	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					472.00	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	098	2	1	01	01	H0562_098_2	3	6	Select Care Drugs	1	3	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	099	1	1	01	01	H0562_099_1	3	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	099	1	1	01	01	H0562_099_1	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.13	4.00	8.00	12.00																												0.13	4.00	8.00	8.00				0.13	4.00	8.00	12.00				4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	099	1	1	01	01	H0562_099_1	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	20.00				0.33	10.00	20.00	30.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	099	1	1	01	01	H0562_099_1	3	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	099	1	1	01	01	H0562_099_1	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	099	1	1	01	01	H0562_099_1	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					389.25	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	099	1	1	01	01	H0562_099_1	3	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.13	4.00	8.00	12.00																												0.13	4.00	8.00	8.00				0.13	4.00	8.00	12.00				4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	099	1	1	01	01	H0562_099_1	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	20.00				0.33	10.00	20.00	30.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	099	1	1	01	01	H0562_099_1	3	6	Select Care Drugs	3	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	099	2	1	01	01	H0562_099_2	3	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	099	2	1	01	01	H0562_099_2	3	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.13	4.00	8.00	12.00																												0.13	4.00	8.00	8.00				0.13	4.00	8.00	12.00				4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	099	2	1	01	01	H0562_099_2	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	20.00				0.33	10.00	20.00	30.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	099	2	1	01	01	H0562_099_2	3	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	099	2	1	01	01	H0562_099_2	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	20.00				0.33	10.00	20.00	30.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	099	2	1	01	01	H0562_099_2	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	099	2	1	01	01	H0562_099_2	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					389.25	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	099	2	1	01	01	H0562_099_2	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.13	4.00	8.00	12.00																												0.13	4.00	8.00	8.00				0.13	4.00	8.00	12.00				4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	099	2	1	01	01	H0562_099_2	3	6	Select Care Drugs	3	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	1	1	01	01	H0562_100_1	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					405.05	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	3	6	Select Care Drugs	3	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	1	1	01	01	H0562_100_1	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	1	1	01	01	H0562_100_1	3	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.13	4.00	8.00	12.00																												0.13	4.00	8.00	8.00				0.13	4.00	8.00	12.00				4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	1	1	01	01	H0562_100_1	3	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.13	4.00	8.00	12.00																												0.13	4.00	8.00	8.00				0.13	4.00	8.00	12.00				4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	3	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.13	4.00	8.00	12.00																												0.13	4.00	8.00	8.00				0.13	4.00	8.00	12.00				4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	2	1	01	01	H0562_100_2	3	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.13	4.00	8.00	12.00																												0.13	4.00	8.00	8.00				0.13	4.00	8.00	12.00				4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	2	1	01	01	H0562_100_2	3	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	3	6	Select Care Drugs	3	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	2	1	01	01	H0562_100_2	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	3	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					405.05	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					334.99	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	238.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	3	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	3	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	3	6	Select Care Drugs	3	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	1	1	01	01	H0562_101_1	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	1	1	01	01	H0562_101_1	3	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	2	1	01	01	H0562_101_2	3	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	3	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	238.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	3	6	Select Care Drugs	3	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	2	1	01	01	H0562_101_2	3	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	3	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	2	1	01	01	H0562_101_2	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00				10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	2	1	01	01	H0562_101_2	3	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					334.99	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	102	0	1	01	01	H0562_102_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	20.00				0.33	10.00	20.00	30.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	102	0	1	01	01	H0562_102_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.66	20.00	40.00	60.00																												0.66	20.00	40.00	40.00				0.66	20.00	40.00	60.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	102	0	1	01	01	H0562_102_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	102	0	1	01	01	H0562_102_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					408.61	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	102	0	1	01	01	H0562_102_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	102	0	1	01	01	H0562_102_0	4	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.13	4.00	8.00	12.00																												0.13	4.00	8.00	8.00				0.13	4.00	8.00	12.00				4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					282.06	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.40	12.00	24.00	36.00																												.40	12.00	24.00	24.00				.40	12.00	24.00	36.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	006	0	1	01	01	H0564_006_0	7	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													58.00	33	33	33					58.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	006	0	1	01	01	H0564_006_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	006	0	1	01	01	H0564_006_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	006	0	1	01	01	H0564_006_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.41	14.00	28.00	42.00					.56	19.00	38.00	57.00					0.41	14.00	28.00	28.00																		19.00				.56	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	006	0	1	01	01	H0564_006_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					0.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	006	0	1	01	01	H0564_006_0	7	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	047	0	1	01	01	H0564_047_0	7	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.00	33	33	33					61.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	047	0	1	01	01	H0564_047_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	047	0	1	01	01	H0564_047_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	047	0	1	01	01	H0564_047_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.50	17.00	34.00	51.00					0.65	22.00	44.00	66.00					0.50	17.00	34.00	34.00																		22.00				.65	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	047	0	1	01	01	H0564_047_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	047	0	1	01	01	H0564_047_0	7	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	052	0	1	01	01	H0564_052_0	6	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					0.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	052	0	1	01	01	H0564_052_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.56	19.00	38.00	57.00					.71	24.00	48.00	72.00					.56	19.00	38.00	38.00																		24.00				.71	24.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	052	0	1	01	01	H0564_052_0	6	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.03	35.00	70.00	105.00					1.18	40.00	80.00	120.00					1.03	35.00	105.00	105.00																		40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	052	0	1	01	01	H0564_052_0	6	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.50	85.00	170.00	255.00					2.65	90.00	180.00	270.00					2.50	85.00	255.00	255.00																		90.00				2.65	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	052	0	1	01	01	H0564_052_0	6	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.00	33	33	33					61.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	052	0	1	01	01	H0564_052_0	6	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	054	0	1	01	01	H0564_054_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	054	0	1	01	01	H0564_054_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.50	17.00	34.00	51.00					0.65	22.00	44.00	66.00					0.50	17.00	34.00	34.00																		22.00				.65	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	054	0	1	01	01	H0564_054_0	8	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	054	0	1	01	01	H0564_054_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	054	0	1	01	01	H0564_054_0	8	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.00	33	33	33					61.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0564	054	0	1	01	01	H0564_054_0	8	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	100		1				31	60	90	1			90					14	31									.09	3.00	6.00	6.00					.09	3.00	6.00	9.00								6.00																			3.00			.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	10	100		1				31	60	90	1			90					14	31									.22	7.00	14.00	14.00					.22	7.00	14.00	21.00								14.00																			7.00			.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	6	5	Specialty Tier	1	4	100001	1	1		111	10	100		1				31	60	90	2			90					14	31													321.44	20	20	20					321.44	20	20	20							20																		20			20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	10	100		1				31	60	90	1			90					14	31									1.93	60.00	120.00	120.00					1.93	60.00	120.00	180.00								120.00																			60.00			1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	6	3	Preferred Brand	1	4	000001	1	2		111	10	100		1				31	60	90	1			90					14	31									1.29	40.00	80.00	80.00					1.29	40.00	80.00	120.00								80.00																			40.00			1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	017	0	1	18	06	H0602_017_0	7	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	2			90				30		31									1.00	30.00		75.00					1.00	30.00		90.00								75.00																		30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	017	0	1	18	06	H0602_017_0	7	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	2			90				30		31									1.50	45.00		112.50					1.50	45.00		135.00								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	017	0	1	18	06	H0602_017_0	7	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	2			90				30		31									2.50	75.00		187.50					2.50	75.00		225.00								187.50																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	017	0	1	18	06	H0602_017_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	2			90				30		31									.10	3.00		7.50					.10	3.00		9.00								7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	017	0	1	18	06	H0602_017_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													1087.83	33							1087.83	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	2			90				30		31									1.33	40.00		100.00					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	6	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	2			90				30		31									.83	25.00		62.50					.83	25.00		75.00								62.50																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	2			90				30		31									.10	3.00		7.50					.10	3.00		9.00								7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	2			90				30		31									2.00	60.00		150.00					2.00	60.00		180.00								150.00																		60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	6	2	Non-Preferred Generic	3	4	000110	1	2		110	01	100		1				30		90	2			90				30		31									.83	25.00		62.50					.83	25.00		75.00								62.50																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0602	019	0	1	18	06	H0602_019_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	2			90				30		31									.10	3.00		7.50					.10	3.00		9.00								7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0602	019	0	1	18	06	H0602_019_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													2504.42	33							2504.42	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	020	0	1	18	06	H0602_020_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	2			90				30		31									.10	3.00		7.50					.10	3.00		9.00								7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	020	0	1	18	06	H0602_020_0	7	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	2			90				30		31									2.50	75.00		187.50					2.50	75.00		225.00								187.50																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	020	0	1	18	06	H0602_020_0	7	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	2			90				30		31									1.50	45.00		112.50					1.50	45.00		135.00								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	020	0	1	18	06	H0602_020_0	7	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	2			90				30		31									1.00	30.00		75.00					1.00	30.00		90.00								75.00																		30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	020	0	1	18	06	H0602_020_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													972.23	33							972.23	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	2			90				30		31									2.50	75.00		187.50					2.50	75.00		225.00								187.50																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	2			90				30		31									1.50	45.00		112.50					1.50	45.00		135.00								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	6	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	2			90				30		31									1.00	30.00		75.00					1.00	30.00		90.00								75.00																		30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	2			90				30		31									.10	3.00		7.50					.10	3.00		9.00								7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													1126.17	33							1126.17	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	039	0	1	18	06	H0602_039_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	2			90				30		31									.10	3.00		7.50					.10	3.00		9.00								7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	039	0	1	18	06	H0602_039_0	7	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	2			90				30		31									.83	25.00		62.50					.83	25.00		75.00								62.50																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	039	0	1	18	06	H0602_039_0	7	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	2			90				30		31									1.50	45.00		112.50					1.50	45.00		135.00								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	039	0	1	18	06	H0602_039_0	7	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	2			90				30		31									3.00	90.00		225.00					3.00	90.00		270.00								225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	039	0	1	18	06	H0602_039_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													612.72	31							612.72	31							31																			31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	6	1	Preferred Generic	1	3	001000	1	2		110	01	100		1				30		90	2			90				30		31									.10	3.00		7.50					.10	3.00		9.00								7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	6	2	Non-Preferred Generic	1	3	000110	1	2		110	01	100		1				30		90	2			90				30		31									.83	25.00		62.50					.83	25.00		75.00								62.50																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	6	3	Preferred Brand	1	3	010001	1	2		110	01	100		1				30		90	2			90				30		31									1.33	40.00		100.00					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	6	4	Non-Preferred Brand	1	3	110000	1	2		110	01	100		1				30		90	2			90				30		31									2.66	80.00		200.00					2.66	80.00		240.00								200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	6	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		31													942.50	30							942.50	30							30																			30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.20	6.00		18.00																															12.00							18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0609	002	0	1	01	01	H0609_002_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0609	002	0	1	01	01	H0609_002_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					589.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.03	91.00		273.00																															263.00							273.00				91.00				2.93	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.20	6.00		18.00																															12.00							18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.40	42.00		126.00																															116.00							126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.20	6.00		18.00																															12.00							18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.03	91.00		273.00																															263.00							273.00				91.00				2.93	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.40	42.00		126.00																															116.00							126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					578.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					553.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					554.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	006	0	1	01	01	H0621_006_0	10	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	006	0	1	01	01	H0621_006_0	10	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	.30	9.00		27.00																								18.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	006	0	1	01	01	H0621_006_0	10	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	006	0	1	01	01	H0621_006_0	10	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	006	0	1	01	01	H0621_006_0	10	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31					902.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	010	0	1	01	01	H0621_010_0	8	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	010	0	1	01	01	H0621_010_0	8	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.56	17.00		51.00																								34.00																		17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	010	0	1	01	01	H0621_010_0	8	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	010	0	1	01	01	H0621_010_0	8	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0621	010	0	1	01	01	H0621_010_0	8	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31					721.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0630	013	0	1	01	01	H0630_013_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	6	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	013	0	1	01	01	H0630_013_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	013	0	1	01	01	H0630_013_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.23	7.00		21.00																					.23	7.00		14.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	013	0	1	01	01	H0630_013_0	6	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					756.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.23	7.00		21.00																					.23	7.00		14.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.20	6.00		18.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	015	0	1	01	01	H0630_015_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.20	6.00		18.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	015	0	1	01	01	H0630_015_0	6	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	6	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	015	0	1	01	01	H0630_015_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					697.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.33	40.00		120.00																					1.33	40.00		80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.13	4.00		12.00																					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					706.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	016	0	1	01	01	H0630_016_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	016	0	1	01	01	H0630_016_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.13	4.00		12.00																					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	016	0	1	01	01	H0630_016_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.23	7.00		21.00																					.23	7.00		14.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	7	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	017	0	1	01	01	H0630_017_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	017	0	1	01	01	H0630_017_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.23	7.00		21.00																					.23	7.00		14.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	017	0	1	01	01	H0630_017_0	7	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	7	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					873.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.23	7.00		21.00																					.23	7.00		14.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					1059.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.23	7.00		21.00																					.23	7.00		14.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	018	0	1	01	01	H0630_018_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	018	0	1	01	01	H0630_018_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	019	0	1	02	01	H0630_019_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	019	0	1	02	01	H0630_019_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	019	0	1	02	01	H0630_019_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	019	0	1	02	01	H0630_019_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					937.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	019	0	1	02	01	H0630_019_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	019	0	1	02	01	H0630_019_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.20	6.00		18.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	019	0	1	02	01	H0630_019_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	019	0	1	02	01	H0630_019_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	019	0	1	02	01	H0630_019_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.20	6.00		18.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.23	7.00		21.00																					.23	7.00		14.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	020	0	1	01	01	H0630_020_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	020	0	1	01	01	H0630_020_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.23	7.00		21.00																					.23	7.00		14.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	020	0	1	01	01	H0630_020_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					708.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.20	6.00		18.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	021	0	1	01	01	H0630_021_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.20	6.00		18.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	021	0	1	01	01	H0630_021_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	021	0	1	01	01	H0630_021_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					703.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0712	001	0	1	02	01	H0712_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.25	8.00	16.00	24.00					.41	13.00	26.00	39.00												.25	8.00	16.00	16.00				.41	13.00	26.00	39.00				13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	001	0	1	02	01	H0712_001_0	5	3	Preferred Brand	1	4	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	001	0	1	02	01	H0712_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.09	3.00	6.00	9.00					.22	7.00	14.00	21.00												.09	3.00	6.00	0.00				.22	7.00	14.00	21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	001	0	1	02	01	H0712_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.54	79.00	158.00	237.00					3.03	94.00	188.00	282.00												2.54	79.00	158.00	158.00				3.03	94.00	188.00	282.00				94.00				3.03	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	001	0	1	02	01	H0712_001_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.12	4.00	8.00	12.00					.64	20.00	40.00	60.00												.12	4.00	8.00	8.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.32	10.00	20.00	30.00												0.00	0.00	0.00	0.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.64	20.00	40.00	60.00					1.45	45.00	90.00	135.00												.64	20.00	40.00	40.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.61	50.00	100.00	150.00					3.06	95.00	190.00	285.00												1.61	50.00	100.00	100.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	6	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.25	8.00	16.00	24.00					.41	13.00	26.00	39.00												.25	8.00	16.00	16.00				.41	13.00	26.00	39.00				13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	6	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.58	80.00	160.00	240.00					3.06	95.00	190.00	285.00												2.58	80.00	160.00	160.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	6	3	Preferred Brand	1	4	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.80	25.00	50.00	75.00					1.45	45.00	90.00	135.00												.80	25.00	50.00	50.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.12	4.00	8.00	12.00					.64	20.00	40.00	60.00												.12	4.00	8.00	8.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.19	6.00	12.00	18.00												0.00	0.00	0.00	0.00				.19	6.00	12.00	18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.87	58.00	116.00	174.00					2.90	90.00	180.00	270.00												1.87	58.00	116.00	116.00				2.90	90.00	180.00	270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0755	030	0	1	01	01	H0755_030_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					567.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.43	43.00		129.00																															119.00							129.00				43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.20	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	5	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	5	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					531.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	5	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0773	001	0	1	48	05	H0773_001_0	7	1	Generic Drugs	1	4	010000			110		01	111		1	30		90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0773	001	0	1	48	05	H0773_001_0	7	2	Brand Drugs	1	4	000010			110		01	111		1	30		90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs	1											
H0773	001	0	1	48	05	H0773_001_0	7	3	Non-Medicare Rx Generic Drugs	1	4	010000			110		01	111		1	30		90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0773	001	0	1	48	05	H0773_001_0	7	4	Non-Medicare Rx Brand Drugs	1	4	000010			110		01	111		1	30		90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0773	001	0	1	48	05	H0773_001_0	7	5	Non-Medicare OTC Generic Drugs	1	4	010000			110		01	111		1	30		90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0773	001	0	1	48	05	H0773_001_0	7	6	Non-Medicare OTC Brand Drugs	1	4	000010			110		01	111		1	30		90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0838	022	0	1	01	01	H0838_022_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								27.00																		9.00				.30	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0838	022	0	1	01	01	H0838_022_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.29	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	022	0	1	01	01	H0838_022_0	7	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					583.06	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	022	0	1	01	01	H0838_022_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.00	90.00		270.00																								270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	022	0	1	01	01	H0838_022_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0838	022	0	1	01	01	H0838_022_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								27.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	022	0	1	01	01	H0838_022_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.10	3.00		9.00																								9.00																		3.00				.06	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	025	0	1	01	01	H0838_025_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.33	40.00		120.00																								120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	025	0	1	01	01	H0838_025_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.17	5.00		15.00																								14.00																		5.00				.17	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0838	025	0	1	01	01	H0838_025_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								14.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	025	0	1	01	01	H0838_025_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	025	0	1	01	01	H0838_025_0	7	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					583.02	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	025	0	1	01	01	H0838_025_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.00	90.00		270.00																								265.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	026	0	1	01	01	H0838_026_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.00	90.00		270.00																								270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	026	0	1	01	01	H0838_026_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								27.00																		9.00				.30	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0838	026	0	1	01	01	H0838_026_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.10	3.00		9.00																								9.00																		3.00				.06	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	026	0	1	01	01	H0838_026_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								27.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	026	0	1	01	01	H0838_026_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.29	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	026	0	1	01	01	H0838_026_0	6	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					566.97	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	026	0	1	01	01	H0838_026_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0838	028	0	1	01	01	H0838_028_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.10	3.00		9.00																								9.00																		3.00				.06	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	028	0	1	01	01	H0838_028_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								27.00																		9.00				.30	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0838	028	0	1	01	01	H0838_028_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0838	028	0	1	01	01	H0838_028_0	6	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					567.14	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	028	0	1	01	01	H0838_028_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.00	90.00		270.00																								270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	028	0	1	01	01	H0838_028_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.29	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0838	028	0	1	01	01	H0838_028_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.30	9.00		27.00																								27.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0840	001	0	1	04	01	H0840_001_0	16	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					10	31					700.00	30	30	30																					30	30	30																		30			30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0840	001	0	1	04	01	H0840_001_0	16	4	Non-Preferred Brand	1	4	100100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	2.33	70.00	140.00	210.00																					2.33	70.00	140.00	140.00																			70.00			2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0840	001	0	1	04	01	H0840_001_0	16	3	Preferred Brand	1	4	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	.99	30.00	60.00	90.00																					.99	30.00	60.00	60.00																			30.00			.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0840	001	0	1	04	01	H0840_001_0	16	1	Preferred Generic	1	4	001001	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0840	001	0	1	04	01	H0840_001_0	16	2	Non-Preferred Generic	1	4	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	.22	7.00	14.00	21.00																					.22	7.00	14.00	14.00																			7.00			.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0879	001	0	1	04	01	H0879_001_0	14	5	Specialty Tier	1	4	100000	1	1		110	01	100		1				31		90	1			90				31		34													150.00	33		33					150.00	33		33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0879	001	0	1	04	01	H0879_001_0	14	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		90	1			90				31		34									0.00	0.00		0.00					0.10	3.00		7.50								7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0879	001	0	1	04	01	H0879_001_0	14	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				31		90	1			90				31		34									0.00	0.00		0.00					0.32	10.00		25.00								25.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0879	001	0	1	04	01	H0879_001_0	14	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				31		90	1			90				31		34									1.13	35.00		87.50					1.13	35.00		87.50								87.50																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0879	001	0	1	04	01	H0879_001_0	14	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				31		90	1			90				31		34									2.58	80.00		200.00					2.58	80.00		200.00								200.00																		80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0879	002	0	1	04	01	H0879_002_0	14	5	Specialty Tier	1	4	100000	1	1		110	01	100		1				31		90	1			90				31		34													150.00	33		33					150.00	33		33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0879	002	0	1	04	01	H0879_002_0	14	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		90	1			90				31		34									0.00	0.00		0.00					0.16	5.00		12.50								12.50																		5.00				0.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0879	002	0	1	04	01	H0879_002_0	14	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				31		90	1			90				31		34									0.16	5.00		12.50					0.48	15.00		37.50								37.50																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0879	002	0	1	04	01	H0879_002_0	14	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				31		90	1			90				31		34									1.45	45.00		112.50					1.45	45.00		112.50								112.50																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0879	002	0	1	04	01	H0879_002_0	14	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				31		90	1			90				31		34									3.06	95.00		237.50					3.06	95.00		237.50								237.50																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0901	004	0	1	01	01	H0901_004_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0901	004	0	1	01	01	H0901_004_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0901	004	0	1	01	01	H0901_004_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0901	004	0	1	01	01	H0901_004_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0901	004	0	1	01	01	H0901_004_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0901	004	0	1	01	01	H0901_004_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0908	001	0	1	01	01	H0908_001_0	8	4	Injectable Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H0908	001	0	1	01	01	H0908_001_0	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H0908	001	0	1	01	01	H0908_001_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.45	45.00		45.00																								45.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H0908	001	0	1	01	01	H0908_001_0	8	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H0913	002	0	1	01	01	H0913_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.25	70.00	140.00	210.00					2.74	85.00	170.00	255.00												2.25	70.00	140.00	140.00				2.74	85.00	170.00	255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	002	0	1	01	01	H0913_002_0	6	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	002	0	1	01	01	H0913_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.70	22.00	44.00	66.00												.48	15.00	30.00	30.00				.70	22.00	44.00	66.00				22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	002	0	1	01	01	H0913_002_0	6	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	002	0	1	01	01	H0913_002_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0927	001	0	1	48	05	H0927_001_0	8	2	Brand Drugs	1	4	100000			010		01	010		1	30							30						30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0927	001	0	1	48	05	H0927_001_0	8	1	Generic Drugs	1	4	001101			010		01	010		1	30							30						30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0927	001	0	1	48	05	H0927_001_0	8	3	Non-Medicare OTC Drugs	1	4	010010			010		01	010		1	30							30						30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0979	022	0	1	09	04	H0979_022_0	4	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0979	022	0	1	09	04	H0979_022_0	4	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.13	4.00		12.00																					0.13	4.00		10.00																		4.00				0.12	4.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0979	022	0	1	09	04	H0979_022_0	4	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0979	022	0	1	09	04	H0979_022_0	4	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	011	0	1	01	01	H1013_011_0	15	1	Preferred Generic	1	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					.10	3.00	6.00	6.00					0.00	0.00	0.00	0.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	011	0	1	01	01	H1013_011_0	15	2	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					.33	10.00	20.00	20.00					0.00	0.00	0.00	0.00																		10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	011	0	1	01	01	H1013_011_0	15	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.00	30.00	60.00	90.00					1.50	45.00	90.00	135.00					1.00	30.00	60.00	90.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	011	0	1	01	01	H1013_011_0	15	4	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	011	0	1	01	01	H1013_011_0	15	1	Preferred Generic	3	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					.10	3.00	6.00	6.00					0.00	0.00	0.00	0.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1013	021	0	1	01	01	H1013_021_0	8	1	Preferred Generic	1	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	021	0	1	01	01	H1013_021_0	8	2	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	70.00					1.50	45.00	90.00	90.00					1.16	35.00	70.00	70.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	021	0	1	01	01	H1013_021_0	8	4	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	021	0	1	01	01	H1013_021_0	8	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.50	75.00	150.00	225.00					3.00	90.00	180.00	270.00					2.50	75.00	150.00	225.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	024	0	1	01	01	H1013_024_0	8	1	Preferred Generic	1	4	001010	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	024	0	1	01	01	H1013_024_0	8	3	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	024	0	1	01	01	H1013_024_0	8	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.50	45.00	90.00	90.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1013	024	0	1	01	01	H1013_024_0	8	4	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	8	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	8	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	.16	5.00		15.00																								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	8	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	.83	25.00		75.00																								75.00																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	8	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					696.39	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	8	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1016	001	0	1	01	01	H1016_001_0	8	2	Non-Preferred Generic	3	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1016	021	0	1	01	01	H1016_021_0	6	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		12.00																								0.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.16	35.00		105.00																								105.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	6	2	Non-Preferred Generic	3	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		12.00																								12.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1016	021	0	1	01	01	H1016_021_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					696.39	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	2.33	70.00		210.00																								210.00																		70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	022	0	1	01	01	H1016_022_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	022	0	1	01	01	H1016_022_0	6	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		12.00																								0.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	022	0	1	01	01	H1016_022_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					696.39	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	022	0	1	01	01	H1016_022_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	2.33	70.00		210.00																								210.00																		70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	022	0	1	01	01	H1016_022_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.16	35.00		105.00																								105.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	022	0	1	01	01	H1016_022_0	6	2	Non-Preferred Generic	3	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		12.00																								12.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	001	0	1	01	01	H1019_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.66	50.00		150.00																												1.66	50.00		140.00				1.66	50.00		150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	001	0	1	01	01	H1019_001_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.66	50.00		150.00																												1.66	50.00		140.00				1.66	50.00		150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	001	0	1	01	01	H1019_001_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	001	0	1	01	01	H1019_001_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	001	0	1	01	01	H1019_001_0	5	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	001	0	1	01	01	H1019_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	006	0	1	01	01	H1019_006_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		5.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	006	0	1	01	01	H1019_006_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	006	0	1	01	01	H1019_006_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	006	0	1	01	01	H1019_006_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		5.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	5	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	010	0	1	01	01	H1019_010_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	010	0	1	01	01	H1019_010_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	010	0	1	01	01	H1019_010_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	010	0	1	01	01	H1019_010_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	010	0	1	01	01	H1019_010_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	010	0	1	01	01	H1019_010_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	010	0	1	01	01	H1019_010_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	010	0	1	01	01	H1019_010_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	010	0	1	01	01	H1019_010_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	010	0	1	01	01	H1019_010_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	014	0	1	01	01	H1019_014_0	6	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	014	0	1	01	01	H1019_014_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	014	0	1	01	01	H1019_014_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	014	0	1	01	01	H1019_014_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	014	0	1	01	01	H1019_014_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.83	25.00		75.00																												0.83	25.00		65.00				0.83	25.00		75.00				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	014	0	1	01	01	H1019_014_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	014	0	1	01	01	H1019_014_0	6	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	3
H1019	014	0	1	01	01	H1019_014_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	014	0	1	01	01	H1019_014_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	014	0	1	01	01	H1019_014_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.83	25.00		75.00																												0.83	25.00		65.00				0.83	25.00		75.00				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	6	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	6	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	025	0	1	01	01	H1019_025_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	025	0	1	01	01	H1019_025_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	025	0	1	01	01	H1019_025_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	025	0	1	01	01	H1019_025_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	025	0	1	01	01	H1019_025_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	027	0	1	01	01	H1019_027_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	027	0	1	01	01	H1019_027_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	027	0	1	01	01	H1019_027_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	027	0	1	01	01	H1019_027_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	027	0	1	01	01	H1019_027_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	027	0	1	01	01	H1019_027_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	027	0	1	01	01	H1019_027_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1019	027	0	1	01	01	H1019_027_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	027	0	1	01	01	H1019_027_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	027	0	1	01	01	H1019_027_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	028	0	1	01	01	H1019_028_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	028	0	1	01	01	H1019_028_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	028	0	1	01	01	H1019_028_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	028	0	1	01	01	H1019_028_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	028	0	1	01	01	H1019_028_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	032	0	1	01	01	H1019_032_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	032	0	1	01	01	H1019_032_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.66	50.00		150.00																												1.66	50.00		140.00				1.66	50.00		150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	032	0	1	01	01	H1019_032_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	032	0	1	01	01	H1019_032_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	032	0	1	01	01	H1019_032_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.66	50.00		150.00																												1.66	50.00		140.00				1.66	50.00		150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	032	0	1	01	01	H1019_032_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	032	0	1	01	01	H1019_032_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	032	0	1	01	01	H1019_032_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	032	0	1	01	01	H1019_032_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	032	0	1	01	01	H1019_032_0	4	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	043	0	1	01	01	H1019_043_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1019	043	0	1	01	01	H1019_043_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	043	0	1	01	01	H1019_043_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	043	0	1	01	01	H1019_043_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	043	0	1	01	01	H1019_043_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	045	0	1	01	01	H1019_045_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	045	0	1	01	01	H1019_045_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	045	0	1	01	01	H1019_045_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	045	0	1	01	01	H1019_045_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	045	0	1	01	01	H1019_045_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	046	0	1	01	01	H1019_046_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	046	0	1	01	01	H1019_046_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	046	0	1	01	01	H1019_046_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	046	0	1	01	01	H1019_046_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	046	0	1	01	01	H1019_046_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	047	0	1	01	01	H1019_047_0	6	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	047	0	1	01	01	H1019_047_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	047	0	1	01	01	H1019_047_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	047	0	1	01	01	H1019_047_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	047	0	1	01	01	H1019_047_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	048	0	1	01	01	H1019_048_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	048	0	1	01	01	H1019_048_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.03	91.00		273.00																												3.03	91.00		263.00				3.03	91.00		273.00				91.00				2.93	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	048	0	1	01	01	H1019_048_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	048	0	1	01	01	H1019_048_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	048	0	1	01	01	H1019_048_0	7	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	049	0	1	01	01	H1019_049_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	049	0	1	01	01	H1019_049_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	049	0	1	01	01	H1019_049_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	049	0	1	01	01	H1019_049_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	049	0	1	01	01	H1019_049_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	050	0	1	01	01	H1019_050_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	050	0	1	01	01	H1019_050_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	050	0	1	01	01	H1019_050_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	050	0	1	01	01	H1019_050_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	050	0	1	01	01	H1019_050_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	5	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	054	0	1	01	01	H1019_054_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	054	0	1	01	01	H1019_054_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		20.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	054	0	1	01	01	H1019_054_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	054	0	1	01	01	H1019_054_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	054	0	1	01	01	H1019_054_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		20.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	057	0	1	01	01	H1019_057_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	057	0	1	01	01	H1019_057_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	057	0	1	01	01	H1019_057_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	057	0	1	01	01	H1019_057_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	057	0	1	01	01	H1019_057_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	059	0	1	01	01	H1019_059_0	3	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	059	0	1	01	01	H1019_059_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	059	0	1	01	01	H1019_059_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	059	0	1	01	01	H1019_059_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		20.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	059	0	1	01	01	H1019_059_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	059	0	1	01	01	H1019_059_0	3	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	3
H1019	059	0	1	01	01	H1019_059_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	059	0	1	01	01	H1019_059_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	059	0	1	01	01	H1019_059_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		20.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	059	0	1	01	01	H1019_059_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	060	0	1	01	01	H1019_060_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	060	0	1	01	01	H1019_060_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	060	0	1	01	01	H1019_060_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	060	0	1	01	01	H1019_060_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	060	0	1	01	01	H1019_060_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1019	061	0	1	01	01	H1019_061_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	061	0	1	01	01	H1019_061_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	061	0	1	01	01	H1019_061_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	061	0	1	01	01	H1019_061_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	061	0	1	01	01	H1019_061_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	062	0	1	01	01	H1019_062_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	062	0	1	01	01	H1019_062_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	062	0	1	01	01	H1019_062_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	062	0	1	01	01	H1019_062_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.66	50.00		150.00																												1.66	50.00		140.00				1.66	50.00		150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	062	0	1	01	01	H1019_062_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	062	0	1	01	01	H1019_062_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	062	0	1	01	01	H1019_062_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	062	0	1	01	01	H1019_062_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	062	0	1	01	01	H1019_062_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.66	50.00		150.00																												1.66	50.00		140.00				1.66	50.00		150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	062	0	1	01	01	H1019_062_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	063	0	1	01	01	H1019_063_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	063	0	1	01	01	H1019_063_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	063	0	1	01	01	H1019_063_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		5.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	063	0	1	01	01	H1019_063_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	063	0	1	01	01	H1019_063_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	063	0	1	01	01	H1019_063_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	063	0	1	01	01	H1019_063_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	063	0	1	01	01	H1019_063_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		5.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	063	0	1	01	01	H1019_063_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	063	0	1	01	01	H1019_063_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	064	0	1	01	01	H1019_064_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	064	0	1	01	01	H1019_064_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	064	0	1	01	01	H1019_064_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	064	0	1	01	01	H1019_064_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	064	0	1	01	01	H1019_064_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	064	0	1	01	01	H1019_064_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	064	0	1	01	01	H1019_064_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	064	0	1	01	01	H1019_064_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	064	0	1	01	01	H1019_064_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	064	0	1	01	01	H1019_064_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	065	0	1	01	01	H1019_065_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.46	44.00		132.00																												1.46	44.00		122.00				1.46	44.00		132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	065	0	1	01	01	H1019_065_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	065	0	1	01	01	H1019_065_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1019	065	0	1	01	01	H1019_065_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.46	44.00		132.00																												1.46	44.00		122.00				1.46	44.00		132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	066	0	1	01	01	H1019_066_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	066	0	1	01	01	H1019_066_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	066	0	1	01	01	H1019_066_0	3	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	3
H1019	066	0	1	01	01	H1019_066_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	066	0	1	01	01	H1019_066_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	066	0	1	01	01	H1019_066_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	066	0	1	01	01	H1019_066_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	066	0	1	01	01	H1019_066_0	3	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	066	0	1	01	01	H1019_066_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	066	0	1	01	01	H1019_066_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	067	0	1	01	01	H1019_067_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	067	0	1	01	01	H1019_067_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	067	0	1	01	01	H1019_067_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	067	0	1	01	01	H1019_067_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	067	0	1	01	01	H1019_067_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	067	0	1	01	01	H1019_067_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1019	067	0	1	01	01	H1019_067_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	067	0	1	01	01	H1019_067_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	067	0	1	01	01	H1019_067_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	067	0	1	01	01	H1019_067_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	068	0	1	01	01	H1019_068_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	068	0	1	01	01	H1019_068_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	068	0	1	01	01	H1019_068_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	068	0	1	01	01	H1019_068_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	068	0	1	01	01	H1019_068_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	068	0	1	01	01	H1019_068_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	068	0	1	01	01	H1019_068_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	068	0	1	01	01	H1019_068_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	068	0	1	01	01	H1019_068_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	068	0	1	01	01	H1019_068_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1019	069	0	1	01	01	H1019_069_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	069	0	1	01	01	H1019_069_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	069	0	1	01	01	H1019_069_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	069	0	1	01	01	H1019_069_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1019	069	0	1	01	01	H1019_069_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	070	0	1	01	01	H1019_070_0	3	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	070	0	1	01	01	H1019_070_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	070	0	1	01	01	H1019_070_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	070	0	1	01	01	H1019_070_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	070	0	1	01	01	H1019_070_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	070	0	1	01	01	H1019_070_0	3	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	070	0	1	01	01	H1019_070_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	070	0	1	01	01	H1019_070_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	070	0	1	01	01	H1019_070_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	070	0	1	01	01	H1019_070_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	071	0	1	01	01	H1019_071_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	071	0	1	01	01	H1019_071_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	071	0	1	01	01	H1019_071_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	071	0	1	01	01	H1019_071_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	071	0	1	01	01	H1019_071_0	3	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	072	0	1	01	01	H1019_072_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	072	0	1	01	01	H1019_072_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	072	0	1	01	01	H1019_072_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	072	0	1	01	01	H1019_072_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	072	0	1	01	01	H1019_072_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	3	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	074	0	1	01	01	H1019_074_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	074	0	1	01	01	H1019_074_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	074	0	1	01	01	H1019_074_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	074	0	1	01	01	H1019_074_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	074	0	1	01	01	H1019_074_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	075	0	1	01	01	H1019_075_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	075	0	1	01	01	H1019_075_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	075	0	1	01	01	H1019_075_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		5.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	075	0	1	01	01	H1019_075_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	075	0	1	01	01	H1019_075_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	075	0	1	01	01	H1019_075_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	075	0	1	01	01	H1019_075_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	075	0	1	01	01	H1019_075_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		5.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	075	0	1	01	01	H1019_075_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	075	0	1	01	01	H1019_075_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	076	0	1	01	01	H1019_076_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1019	076	0	1	01	01	H1019_076_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	076	0	1	01	01	H1019_076_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1019	076	0	1	01	01	H1019_076_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	076	0	1	01	01	H1019_076_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1026	001	0	1	01	01	H1026_001_0	13	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	.80	25.00		75.00																					.80	25.00		75.00																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	13	5	Specialty Tier	3	4	101101	1	1	110		01	110		1	31		90				1	31		90				31		31					1602.51	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1026	001	0	1	01	01	H1026_001_0	13	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	001	0	1	01	01	H1026_001_0	13	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	001	0	1	01	01	H1026_001_0	13	5	Specialty Tier	1	4	101101	1	1	110		01	110		1	31		90				1	31		90				31		31					1602.51	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	13	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	1.61	50.00		150.00																					1.61	50.00		150.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	13	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	038	0	1	01	01	H1026_038_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	038	0	1	01	01	H1026_038_0	9	5	Specialty Tier	1	4	101101	1	1	110		01	110		1	31		90				1	31		90				31		31					1602.51	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	9	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.58	80.00		240.00																					2.58	80.00		240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.12	35.00		105.00																					1.12	35.00		105.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	9	5	Specialty Tier	3	4	101101	1	1	110		01	110		1	31		90				1	31		90				31		31					1602.51	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1026	040	0	1	01	01	H1026_040_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.12	35.00		105.00																					1.12	35.00		105.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	10	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.58	80.00		240.00																					2.58	80.00		240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	10	5	Specialty Tier	3	4	101101	1	1	110		01	110		1	31		90				1	31		90				31		31					1602.51	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1026	040	0	1	01	01	H1026_040_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	040	0	1	01	01	H1026_040_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	040	0	1	01	01	H1026_040_0	10	5	Specialty Tier	1	4	101101	1	1	110		01	110		1	31		90				1	31		90				31		31					1602.51	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	048	0	1	01	01	H1026_048_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	048	0	1	01	01	H1026_048_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	048	0	1	01	01	H1026_048_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	.80	25.00		75.00																					.80	25.00		75.00																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	048	0	1	01	01	H1026_048_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	1.61	50.00		150.00																					1.61	50.00		150.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	048	0	1	01	01	H1026_048_0	8	5	Specialty Tier	1	4	101101	1	1	110		01	110		1	31		90				1	31		90				31		31					1602.51	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	051	0	1	01	01	H1026_051_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.16	5.00		15.00																					.16	5.00		15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	051	0	1	01	01	H1026_051_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.06	2.00		6.00																					.06	2.00		6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	051	0	1	01	01	H1026_051_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		120.00																					1.29	40.00		120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	051	0	1	01	01	H1026_051_0	8	5	Specialty Tier	1	4	101101	1	1	110		01	110		1	31		90				1	31		90				31		31					1602.51	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	051	0	1	01	01	H1026_051_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.90	90.00		270.00																					2.90	90.00		270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	054	0	1	01	01	H1026_054_0	9	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.90	90.00		270.00																					2.90	90.00		270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	054	0	1	01	01	H1026_054_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		120.00																					1.29	40.00		120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	054	0	1	01	01	H1026_054_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.06	2.00		6.00																					.06	2.00		6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	054	0	1	01	01	H1026_054_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.16	5.00		15.00																					.16	5.00		15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	054	0	1	01	01	H1026_054_0	9	5	Specialty Tier	1	4	101101	1	1	110		01	110		1	31		90				1	31		90				31		31					1602.51	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	002	0	1	02	01	H1032_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					2.41	75.00	150.00	225.00												1.93	60.00	120.00	120.00				2.41	75.00	150.00	225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	002	0	1	02	01	H1032_002_0	6	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.80	25.00	50.00	75.00					1.12	35.00	70.00	105.00												.80	25.00	50.00	50.00				1.12	35.00	70.00	105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	002	0	1	02	01	H1032_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.51	16.00	32.00	48.00												.32	10.00	20.00	20.00				.51	16.00	32.00	48.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	002	0	1	02	01	H1032_002_0	6	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	002	0	1	02	01	H1032_002_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	025	0	1	02	01	H1032_025_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.41	75.00	150.00	225.00					2.90	90.00	180.00	270.00												2.41	75.00	150.00	150.00				2.90	90.00	180.00	270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	025	0	1	02	01	H1032_025_0	5	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	025	0	1	02	01	H1032_025_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.51	16.00	32.00	48.00												.32	10.00	20.00	20.00				.51	16.00	32.00	48.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	025	0	1	02	01	H1032_025_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	025	0	1	02	01	H1032_025_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_0	6	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.19	6.00	12.00	18.00					.45	14.00	28.00	42.00												.19	6.00	12.00	12.00				.45	14.00	28.00	42.00				14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_0	6	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.96	30.00	60.00	90.00					1.29	40.00	80.00	120.00												.96	30.00	60.00	60.00				1.29	40.00	80.00	120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.41	75.00	150.00	225.00					2.90	90.00	180.00	270.00												2.41	75.00	150.00	150.00				2.90	90.00	180.00	270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	035	0	1	02	01	H1032_035_0	7	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	035	0	1	02	01	H1032_035_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.51	16.00	32.00	48.00												.32	10.00	20.00	20.00				.51	16.00	32.00	48.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	035	0	1	02	01	H1032_035_0	7	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.64	20.00	40.00	60.00					.96	30.00	60.00	90.00												.64	20.00	40.00	40.00				.96	30.00	60.00	90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	035	0	1	02	01	H1032_035_0	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.77	55.00	110.00	165.00					2.25	70.00	140.00	210.00												1.77	55.00	110.00	110.00				2.25	70.00	140.00	210.00				70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	035	0	1	02	01	H1032_035_0	7	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	040	0	1	02	01	H1032_040_0	5	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.80	25.00	50.00	75.00					1.12	35.00	70.00	105.00												.80	25.00	50.00	50.00				1.12	35.00	70.00	105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	040	0	1	02	01	H1032_040_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.58	49.00	98.00	147.00					2.06	64.00	128.00	192.00												1.58	49.00	98.00	98.00				2.06	64.00	128.00	192.00				64.00				2.06	64.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	040	0	1	02	01	H1032_040_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	040	0	1	02	01	H1032_040_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	040	0	1	02	01	H1032_040_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.51	16.00	32.00	48.00												.32	10.00	20.00	20.00				.51	16.00	32.00	48.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.83	88.00	176.00	264.00					3.06	95.00	190.00	285.00												2.83	88.00	176.00	176.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.12	4.00	8.00	12.00					.64	20.00	40.00	60.00												.12	4.00	8.00	8.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.54	79.00	158.00	237.00					3.03	94.00	188.00	282.00												2.54	79.00	158.00	158.00				3.03	94.00	188.00	282.00				94.00				3.03	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.51	16.00	32.00	48.00												.32	10.00	20.00	20.00				.51	16.00	32.00	48.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	079	0	1	01	01	H1032_079_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	079	0	1	01	01	H1032_079_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.51	16.00	32.00	48.00												.32	10.00	20.00	20.00				.51	16.00	32.00	48.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	079	0	1	01	01	H1032_079_0	5	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	079	0	1	01	01	H1032_079_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.54	79.00	158.00	237.00					3.03	94.00	188.00	282.00												2.54	79.00	158.00	158.00				3.03	94.00	188.00	282.00				94.00				3.03	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	079	0	1	01	01	H1032_079_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_0	6	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.51	16.00	32.00	48.00												.32	10.00	20.00	20.00				.51	16.00	32.00	48.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_0	6	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.80	25.00	50.00	75.00					1.12	35.00	70.00	105.00												.80	25.00	50.00	50.00				1.12	35.00	70.00	105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					2.41	75.00	150.00	225.00												1.93	60.00	120.00	120.00				2.41	75.00	150.00	225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.83	88.00	176.00	264.00					3.06	95.00	190.00	285.00												2.83	88.00	176.00	176.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.12	4.00	8.00	12.00					.64	20.00	40.00	60.00												.12	4.00	8.00	8.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.54	79.00	158.00	237.00					3.03	94.00	188.00	282.00												2.54	79.00	158.00	158.00				3.03	94.00	188.00	282.00				94.00				3.03	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	5	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.51	16.00	32.00	48.00												.32	10.00	20.00	20.00				.51	16.00	32.00	48.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.25	8.00	16.00	24.00					.64	20.00	40.00	60.00												.25	8.00	16.00	16.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.83	88.00	176.00	264.00					3.06	95.00	190.00	285.00												2.83	88.00	176.00	176.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	173	0	1	01	01	H1032_173_0	6	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	173	0	1	01	01	H1032_173_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.51	16.00	32.00	48.00												.32	10.00	20.00	20.00				.51	16.00	32.00	48.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	173	0	1	01	01	H1032_173_0	6	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	173	0	1	01	01	H1032_173_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.41	75.00	150.00	225.00					2.90	90.00	180.00	270.00												2.41	75.00	150.00	150.00				2.90	90.00	180.00	270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	173	0	1	01	01	H1032_173_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	174	0	1	01	01	H1032_174_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.51	16.00	32.00	48.00												.32	10.00	20.00	20.00				.51	16.00	32.00	48.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	174	0	1	01	01	H1032_174_0	6	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	174	0	1	01	01	H1032_174_0	6	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.64	20.00	40.00	60.00					.96	30.00	60.00	90.00												.64	20.00	40.00	40.00				.96	30.00	60.00	90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	174	0	1	01	01	H1032_174_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	174	0	1	01	01	H1032_174_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					2.41	75.00	150.00	225.00												1.93	60.00	120.00	120.00				2.41	75.00	150.00	225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.70	84.00	168.00	252.00					3.06	95.00	190.00	285.00												2.70	84.00	168.00	168.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.22	7.00	14.00	21.00					.64	20.00	40.00	60.00												.22	7.00	14.00	14.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	6	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.70	84.00	168.00	252.00					3.06	95.00	190.00	285.00												2.70	84.00	168.00	168.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	6	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.22	7.00	14.00	21.00					.64	20.00	40.00	60.00												.22	7.00	14.00	14.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	6	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	6	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	177	0	1	01	01	H1032_177_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	177	0	1	01	01	H1032_177_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.51	16.00	32.00	48.00												.32	10.00	20.00	20.00				.51	16.00	32.00	48.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	177	0	1	01	01	H1032_177_0	5	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.80	25.00	50.00	75.00					1.12	35.00	70.00	105.00												.80	25.00	50.00	50.00				1.12	35.00	70.00	105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	177	0	1	01	01	H1032_177_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					2.41	75.00	150.00	225.00												1.93	60.00	120.00	120.00				2.41	75.00	150.00	225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	177	0	1	01	01	H1032_177_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	6	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.09	3.00	6.00	9.00					.19	6.00	12.00	18.00												.09	3.00	6.00	0.00				.19	6.00	12.00	18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.51	16.00	32.00	48.00												.32	10.00	20.00	20.00				.51	16.00	32.00	48.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.41	75.00	150.00	225.00					2.90	90.00	180.00	270.00												2.41	75.00	150.00	150.00				2.90	90.00	180.00	270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	6	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	7	4	Non-Preferred Brand	1	4	100000	1	1		110	01	100		1				31		93	1			93				31		31													83.31	50		50					83.31	50		50							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	002	0	1	02	01	H1035_002_0	7	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				31		93	1			93				31		31									.13	4.00		12.00					.55	17.00		51.00								9.00																		17.00				.55	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs										1		
H1035	002	0	1	02	01	H1035_002_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				31		93	1			93				31		31									0.00	0.00		0.00					.32	10.00		30.00								0.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs										1		
H1035	002	0	1	02	01	H1035_002_0	7	6	Injectable Drugs	1	4	010010	1	1		110	01	100		1				31		93	1			93				31		31													50.36	25		25					111.28	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	002	0	1	02	01	H1035_002_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				31										31		31													611.22	33							611.22	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	002	0	1	02	01	H1035_002_0	7	3	Preferred Brand	1	4	000001	1	1		110	01	100		1				31		93	1			93				31		31													23.32	25		25					27.22	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	002	0	1	02	01	H1035_002_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		93	1			93				31		31									0.00	0.00		0.00					.32	10.00		30.00								0.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	002	0	1	02	01	H1035_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				31		93	1			93				31		31									.13	4.00		12.00					.55	17.00		51.00								9.00																		17.00				.55	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	006	0	1	01	01	H1035_006_0	5	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				31		93	1			93				31		31									.23	7.00		21.00					.55	17.00		51.00								18.00																		17.00				.55	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	006	0	1	01	01	H1035_006_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		93	1			93				31		31									.06	2.00		6.00					.32	10.00		30.00								3.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	006	0	1	01	01	H1035_006_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				31		93	1			93				31		31									1.29	40.00		120.00					1.45	45.00		135.00								117.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	006	0	1	01	01	H1035_006_0	5	6	Injectable Drugs	1	4	010010	1	1		110	01	100		1				31		93	1			93				31		31													42.06	25		25					185.10	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	006	0	1	01	01	H1035_006_0	5	5	Specialty Tier	1	4	010010	1	1		010	01			1				31										31		31													608.68	29							608.68	29																										29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	006	0	1	01	01	H1035_006_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				31		93	1			93				31		31									2.26	70.00		210.00					2.90	90.00		270.00								207.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1036	025	0	1	01	01	H1036_025_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		20.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	025	0	1	01	01	H1036_025_0	4	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	025	0	1	01	01	H1036_025_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	025	0	1	01	01	H1036_025_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		20.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	025	0	1	01	01	H1036_025_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	025	0	1	01	01	H1036_025_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	040	0	1	01	01	H1036_040_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	040	0	1	01	01	H1036_040_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	040	0	1	01	01	H1036_040_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	040	0	1	01	01	H1036_040_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.83	55.00		165.00																												1.83	55.00		155.00				1.83	55.00		165.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	040	0	1	01	01	H1036_040_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	040	0	1	01	01	H1036_040_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	040	0	1	01	01	H1036_040_0	4	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	040	0	1	01	01	H1036_040_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	040	0	1	01	01	H1036_040_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.83	55.00		165.00																												1.83	55.00		155.00				1.83	55.00		165.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	040	0	1	01	01	H1036_040_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	044	0	1	01	01	H1036_044_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	044	0	1	01	01	H1036_044_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	044	0	1	01	01	H1036_044_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	044	0	1	01	01	H1036_044_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	052	0	1	01	01	H1036_052_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	052	0	1	01	01	H1036_052_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	052	0	1	01	01	H1036_052_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	052	0	1	01	01	H1036_052_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	052	0	1	01	01	H1036_052_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		20.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	052	0	1	01	01	H1036_052_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	052	0	1	01	01	H1036_052_0	4	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	052	0	1	01	01	H1036_052_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	052	0	1	01	01	H1036_052_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	052	0	1	01	01	H1036_052_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		20.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	054	0	1	01	01	H1036_054_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		5.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	054	0	1	01	01	H1036_054_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	054	0	1	01	01	H1036_054_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	054	0	1	01	01	H1036_054_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		5.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	5	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	062	0	1	01	01	H1036_062_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	062	0	1	01	01	H1036_062_0	4	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	062	0	1	01	01	H1036_062_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	062	0	1	01	01	H1036_062_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	062	0	1	01	01	H1036_062_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	062	0	1	01	01	H1036_062_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	065	0	1	01	01	H1036_065_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.66	50.00		150.00																												1.66	50.00		140.00				1.66	50.00		150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	065	0	1	01	01	H1036_065_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	065	0	1	01	01	H1036_065_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	065	0	1	01	01	H1036_065_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.66	50.00		150.00																												1.66	50.00		140.00				1.66	50.00		150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	065	0	1	01	01	H1036_065_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	067	0	1	01	01	H1036_067_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.83	55.00		165.00																												1.83	55.00		155.00				1.83	55.00		165.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	067	0	1	01	01	H1036_067_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	067	0	1	01	01	H1036_067_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	067	0	1	01	01	H1036_067_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.83	55.00		165.00																												1.83	55.00		155.00				1.83	55.00		165.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_0	4	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	067	0	1	01	01	H1036_067_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	068	0	1	01	01	H1036_068_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	068	0	1	01	01	H1036_068_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	068	0	1	01	01	H1036_068_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	068	0	1	01	01	H1036_068_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	074	0	1	01	01	H1036_074_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		20.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	074	0	1	01	01	H1036_074_0	4	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	074	0	1	01	01	H1036_074_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	074	0	1	01	01	H1036_074_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		20.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	074	0	1	01	01	H1036_074_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	074	0	1	01	01	H1036_074_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	6	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	081	0	1	01	01	H1036_081_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	081	0	1	01	01	H1036_081_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	081	0	1	01	01	H1036_081_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	081	0	1	01	01	H1036_081_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	081	0	1	01	01	H1036_081_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	7	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.66	50.00		150.00																												1.66	50.00		140.00				1.66	50.00		150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	121	0	1	01	01	H1036_121_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.66	50.00		150.00																												1.66	50.00		140.00				1.66	50.00		150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	121	0	1	01	01	H1036_121_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	121	0	1	01	01	H1036_121_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	121	0	1	01	01	H1036_121_0	5	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	121	0	1	01	01	H1036_121_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	130	0	1	01	01	H1036_130_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	130	0	1	01	01	H1036_130_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	130	0	1	01	01	H1036_130_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	130	0	1	01	01	H1036_130_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	4	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	137	0	1	01	01	H1036_137_0	12	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	12	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	12	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.46	14.00		42.00																												0.46	14.00		0.00				0.46	14.00		42.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	12	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	12	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	12	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	137	0	1	01	01	H1036_137_0	12	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	137	0	1	01	01	H1036_137_0	12	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	137	0	1	01	01	H1036_137_0	12	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.46	14.00		42.00																												0.46	14.00		0.00				0.46	14.00		42.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	137	0	1	01	01	H1036_137_0	12	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	138	0	1	01	01	H1036_138_0	11	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	11	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	11	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	138	0	1	01	01	H1036_138_0	11	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	138	0	1	01	01	H1036_138_0	11	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	138	0	1	01	01	H1036_138_0	11	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	138	0	1	01	01	H1036_138_0	11	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	138	0	1	01	01	H1036_138_0	11	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	11	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	11	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	140	0	1	01	01	H1036_140_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	140	0	1	01	01	H1036_140_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	140	0	1	01	01	H1036_140_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	140	0	1	01	01	H1036_140_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	141	0	1	01	01	H1036_141_0	3	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	141	0	1	01	01	H1036_141_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	141	0	1	01	01	H1036_141_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.83	25.00		75.00																												0.83	25.00		65.00				0.83	25.00		75.00				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	141	0	1	01	01	H1036_141_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	141	0	1	01	01	H1036_141_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	141	0	1	01	01	H1036_141_0	3	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	3
H1036	141	0	1	01	01	H1036_141_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	141	0	1	01	01	H1036_141_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.83	25.00		75.00																												0.83	25.00		65.00				0.83	25.00		75.00				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	141	0	1	01	01	H1036_141_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	141	0	1	01	01	H1036_141_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	143	0	1	01	01	H1036_143_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	143	0	1	01	01	H1036_143_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	143	0	1	01	01	H1036_143_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	143	0	1	01	01	H1036_143_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	146	0	1	01	01	H1036_146_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	146	0	1	01	01	H1036_146_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	146	0	1	01	01	H1036_146_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	146	0	1	01	01	H1036_146_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	151	0	1	01	01	H1036_151_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	151	0	1	01	01	H1036_151_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	151	0	1	01	01	H1036_151_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	151	0	1	01	01	H1036_151_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	151	0	1	01	01	H1036_151_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	152	0	1	01	01	H1036_152_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	152	0	1	01	01	H1036_152_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	152	0	1	01	01	H1036_152_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	152	0	1	01	01	H1036_152_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	152	0	1	01	01	H1036_152_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	153	0	1	01	01	H1036_153_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	153	0	1	01	01	H1036_153_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	153	0	1	01	01	H1036_153_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	153	0	1	01	01	H1036_153_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	154	0	1	01	01	H1036_154_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	154	0	1	01	01	H1036_154_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	154	0	1	01	01	H1036_154_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	154	0	1	01	01	H1036_154_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	154	0	1	01	01	H1036_154_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	156	0	1	01	01	H1036_156_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	156	0	1	01	01	H1036_156_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	156	0	1	01	01	H1036_156_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	156	0	1	01	01	H1036_156_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	156	0	1	01	01	H1036_156_0	5	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	3
H1036	156	0	1	01	01	H1036_156_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	156	0	1	01	01	H1036_156_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	156	0	1	01	01	H1036_156_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	156	0	1	01	01	H1036_156_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	156	0	1	01	01	H1036_156_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	157	0	1	01	01	H1036_157_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	157	0	1	01	01	H1036_157_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	157	0	1	01	01	H1036_157_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.30	9.00		27.00																												0.30	9.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	157	0	1	01	01	H1036_157_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	157	0	1	01	01	H1036_157_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.30	9.00		27.00																												0.30	9.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	159	0	1	01	01	H1036_159_0	3	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	159	0	1	01	01	H1036_159_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	159	0	1	01	01	H1036_159_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	159	0	1	01	01	H1036_159_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	159	0	1	01	01	H1036_159_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	160	0	1	01	01	H1036_160_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	160	0	1	01	01	H1036_160_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		20.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	160	0	1	01	01	H1036_160_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	160	0	1	01	01	H1036_160_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	160	0	1	01	01	H1036_160_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		20.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	160	0	1	01	01	H1036_160_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	160	0	1	01	01	H1036_160_0	4	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	3
H1036	160	0	1	01	01	H1036_160_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	160	0	1	01	01	H1036_160_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	160	0	1	01	01	H1036_160_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	161	0	1	01	01	H1036_161_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	161	0	1	01	01	H1036_161_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	161	0	1	01	01	H1036_161_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	161	0	1	01	01	H1036_161_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	161	0	1	01	01	H1036_161_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	162	0	1	01	01	H1036_162_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	162	0	1	01	01	H1036_162_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	162	0	1	01	01	H1036_162_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	162	0	1	01	01	H1036_162_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	162	0	1	01	01	H1036_162_0	5	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	163	0	1	01	01	H1036_163_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	163	0	1	01	01	H1036_163_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	163	0	1	01	01	H1036_163_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	163	0	1	01	01	H1036_163_0	6	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	163	0	1	01	01	H1036_163_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	164	0	1	01	01	H1036_164_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	164	0	1	01	01	H1036_164_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	164	0	1	01	01	H1036_164_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	164	0	1	01	01	H1036_164_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	164	0	1	01	01	H1036_164_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	164	0	1	01	01	H1036_164_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	164	0	1	01	01	H1036_164_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	164	0	1	01	01	H1036_164_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	164	0	1	01	01	H1036_164_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	164	0	1	01	01	H1036_164_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	6	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	6	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	6	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	6	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	169	0	1	01	01	H1036_169_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	169	0	1	01	01	H1036_169_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	169	0	1	01	01	H1036_169_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	169	0	1	01	01	H1036_169_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	169	0	1	01	01	H1036_169_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	170	0	1	01	01	H1036_170_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	170	0	1	01	01	H1036_170_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	170	0	1	01	01	H1036_170_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	170	0	1	01	01	H1036_170_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	170	0	1	01	01	H1036_170_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	171	0	1	01	01	H1036_171_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	171	0	1	01	01	H1036_171_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	171	0	1	01	01	H1036_171_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	171	0	1	01	01	H1036_171_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	175	0	1	01	01	H1036_175_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	175	0	1	01	01	H1036_175_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	175	0	1	01	01	H1036_175_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	175	0	1	01	01	H1036_175_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	175	0	1	01	01	H1036_175_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	175	0	1	01	01	H1036_175_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	175	0	1	01	01	H1036_175_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	175	0	1	01	01	H1036_175_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	175	0	1	01	01	H1036_175_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	175	0	1	01	01	H1036_175_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	178	0	1	01	01	H1036_178_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	178	0	1	01	01	H1036_178_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	178	0	1	01	01	H1036_178_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	178	0	1	01	01	H1036_178_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	178	0	1	01	01	H1036_178_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	178	0	1	01	01	H1036_178_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	178	0	1	01	01	H1036_178_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	178	0	1	01	01	H1036_178_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	178	0	1	01	01	H1036_178_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	178	0	1	01	01	H1036_178_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	179	0	1	01	01	H1036_179_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	179	0	1	01	01	H1036_179_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	179	0	1	01	01	H1036_179_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	179	0	1	01	01	H1036_179_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	179	0	1	01	01	H1036_179_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	179	0	1	01	01	H1036_179_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	179	0	1	01	01	H1036_179_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	179	0	1	01	01	H1036_179_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	179	0	1	01	01	H1036_179_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	179	0	1	01	01	H1036_179_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	184	0	1	01	01	H1036_184_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	184	0	1	01	01	H1036_184_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	184	0	1	01	01	H1036_184_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	184	0	1	01	01	H1036_184_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.46	14.00		42.00																												0.46	14.00		0.00				0.46	14.00		42.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	184	0	1	01	01	H1036_184_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	184	0	1	01	01	H1036_184_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	184	0	1	01	01	H1036_184_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.46	14.00		42.00																												0.46	14.00		0.00				0.46	14.00		42.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	184	0	1	01	01	H1036_184_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	184	0	1	01	01	H1036_184_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	184	0	1	01	01	H1036_184_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	185	0	1	01	01	H1036_185_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	185	0	1	01	01	H1036_185_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	185	0	1	01	01	H1036_185_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	185	0	1	01	01	H1036_185_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	185	0	1	01	01	H1036_185_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	186	0	1	01	01	H1036_186_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	186	0	1	01	01	H1036_186_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	186	0	1	01	01	H1036_186_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	186	0	1	01	01	H1036_186_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.66	50.00		150.00																												1.66	50.00		140.00				1.66	50.00		150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	186	0	1	01	01	H1036_186_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	186	0	1	01	01	H1036_186_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	186	0	1	01	01	H1036_186_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.66	50.00		150.00																												1.66	50.00		140.00				1.66	50.00		150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	186	0	1	01	01	H1036_186_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	186	0	1	01	01	H1036_186_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	186	0	1	01	01	H1036_186_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	187	0	1	01	01	H1036_187_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	187	0	1	01	01	H1036_187_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	187	0	1	01	01	H1036_187_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	187	0	1	01	01	H1036_187_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	187	0	1	01	01	H1036_187_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	188	0	1	01	01	H1036_188_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	188	0	1	01	01	H1036_188_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		5.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	188	0	1	01	01	H1036_188_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	188	0	1	01	01	H1036_188_0	4	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	188	0	1	01	01	H1036_188_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	188	0	1	01	01	H1036_188_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	188	0	1	01	01	H1036_188_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		5.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	188	0	1	01	01	H1036_188_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	188	0	1	01	01	H1036_188_0	4	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	188	0	1	01	01	H1036_188_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	189	0	1	01	01	H1036_189_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	189	0	1	01	01	H1036_189_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		5.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	189	0	1	01	01	H1036_189_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	189	0	1	01	01	H1036_189_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	189	0	1	01	01	H1036_189_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	189	0	1	01	01	H1036_189_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	189	0	1	01	01	H1036_189_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	189	0	1	01	01	H1036_189_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	189	0	1	01	01	H1036_189_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		5.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	189	0	1	01	01	H1036_189_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	190	0	1	01	01	H1036_190_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	190	0	1	01	01	H1036_190_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	190	0	1	01	01	H1036_190_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	190	0	1	01	01	H1036_190_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	190	0	1	01	01	H1036_190_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	190	0	1	01	01	H1036_190_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	190	0	1	01	01	H1036_190_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	190	0	1	01	01	H1036_190_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	190	0	1	01	01	H1036_190_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	190	0	1	01	01	H1036_190_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	192	0	1	01	01	H1036_192_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	192	0	1	01	01	H1036_192_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	192	0	1	01	01	H1036_192_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	192	0	1	01	01	H1036_192_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	192	0	1	01	01	H1036_192_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	193	0	1	01	01	H1036_193_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	193	0	1	01	01	H1036_193_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	193	0	1	01	01	H1036_193_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	193	0	1	01	01	H1036_193_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	193	0	1	01	01	H1036_193_0	3	1	Preferred Generic	1	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	193	0	1	01	01	H1036_193_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	193	0	1	01	01	H1036_193_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	193	0	1	01	01	H1036_193_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	193	0	1	01	01	H1036_193_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	193	0	1	01	01	H1036_193_0	3	1	Preferred Generic	3	4	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	3
H1036	194	0	1	01	01	H1036_194_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	194	0	1	01	01	H1036_194_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	194	0	1	01	01	H1036_194_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	194	0	1	01	01	H1036_194_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	194	0	1	01	01	H1036_194_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	194	0	1	01	01	H1036_194_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	194	0	1	01	01	H1036_194_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	194	0	1	01	01	H1036_194_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	194	0	1	01	01	H1036_194_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	194	0	1	01	01	H1036_194_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	195	0	1	01	01	H1036_195_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	195	0	1	01	01	H1036_195_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	195	0	1	01	01	H1036_195_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	195	0	1	01	01	H1036_195_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	195	0	1	01	01	H1036_195_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	196	0	1	01	01	H1036_196_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	196	0	1	01	01	H1036_196_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	196	0	1	01	01	H1036_196_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	196	0	1	01	01	H1036_196_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	199	0	1	01	01	H1036_199_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.46	44.00		132.00																												1.46	44.00		122.00				1.46	44.00		132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	199	0	1	01	01	H1036_199_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	199	0	1	01	01	H1036_199_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	199	0	1	01	01	H1036_199_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.46	44.00		132.00																												1.46	44.00		122.00				1.46	44.00		132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	199	0	1	01	01	H1036_199_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	199	0	1	01	01	H1036_199_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	211	0	1	01	01	H1036_211_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	211	0	1	01	01	H1036_211_0	3	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	211	0	1	01	01	H1036_211_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	211	0	1	01	01	H1036_211_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	211	0	1	01	01	H1036_211_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	212	0	1	01	01	H1036_212_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	212	0	1	01	01	H1036_212_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	212	0	1	01	01	H1036_212_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	212	0	1	01	01	H1036_212_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	212	0	1	01	01	H1036_212_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	215	0	1	01	01	H1036_215_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	215	0	1	01	01	H1036_215_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	215	0	1	01	01	H1036_215_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	215	0	1	01	01	H1036_215_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	215	0	1	01	01	H1036_215_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	217	0	1	01	01	H1036_217_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	217	0	1	01	01	H1036_217_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	217	0	1	01	01	H1036_217_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	217	0	1	01	01	H1036_217_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	218	0	1	01	01	H1036_218_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	218	0	1	01	01	H1036_218_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	218	0	1	01	01	H1036_218_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H1036	218	0	1	01	01	H1036_218_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	218	0	1	01	01	H1036_218_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	218	0	1	01	01	H1036_218_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	219	0	1	01	01	H1036_219_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	219	0	1	01	01	H1036_219_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	219	0	1	01	01	H1036_219_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	219	0	1	01	01	H1036_219_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	220	0	1	02	01	H1036_220_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	220	0	1	02	01	H1036_220_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	220	0	1	02	01	H1036_220_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	220	0	1	02	01	H1036_220_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	220	0	1	02	01	H1036_220_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	220	0	1	02	01	H1036_220_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	220	0	1	02	01	H1036_220_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	220	0	1	02	01	H1036_220_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	220	0	1	02	01	H1036_220_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	220	0	1	02	01	H1036_220_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	222	0	1	01	01	H1036_222_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	223	0	1	01	01	H1036_223_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	223	0	1	01	01	H1036_223_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	223	0	1	01	01	H1036_223_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	223	0	1	01	01	H1036_223_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	224	0	1	01	01	H1036_224_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	224	0	1	01	01	H1036_224_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	224	0	1	01	01	H1036_224_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	224	0	1	01	01	H1036_224_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	224	0	1	01	01	H1036_224_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	224	0	1	01	01	H1036_224_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	224	0	1	01	01	H1036_224_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	224	0	1	01	01	H1036_224_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	224	0	1	01	01	H1036_224_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	224	0	1	01	01	H1036_224_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	225	0	1	01	01	H1036_225_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	225	0	1	01	01	H1036_225_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	225	0	1	01	01	H1036_225_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	225	0	1	01	01	H1036_225_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	225	0	1	01	01	H1036_225_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	225	0	1	01	01	H1036_225_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	225	0	1	01	01	H1036_225_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	225	0	1	01	01	H1036_225_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	225	0	1	01	01	H1036_225_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	225	0	1	01	01	H1036_225_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	227	0	1	01	01	H1036_227_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	227	0	1	01	01	H1036_227_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	227	0	1	01	01	H1036_227_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	227	0	1	01	01	H1036_227_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	227	0	1	01	01	H1036_227_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	227	0	1	01	01	H1036_227_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	227	0	1	01	01	H1036_227_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	227	0	1	01	01	H1036_227_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	227	0	1	01	01	H1036_227_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	227	0	1	01	01	H1036_227_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	228	0	1	01	01	H1036_228_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	228	0	1	01	01	H1036_228_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.46	44.00		132.00																												1.46	44.00		122.00				1.46	44.00		132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	228	0	1	01	01	H1036_228_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	228	0	1	01	01	H1036_228_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	228	0	1	01	01	H1036_228_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1036	229	0	1	01	01	H1036_229_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	229	0	1	01	01	H1036_229_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	229	0	1	01	01	H1036_229_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	229	0	1	01	01	H1036_229_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	229	0	1	01	01	H1036_229_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_0	6	1	Preferred Generic	1	4	001000	3	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_0	6	2	Preferred Brand	1	4	010001	3	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_0	6	3	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	.83	25.00		75.00																															65.00							75.00				25.00				.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_0	6	4	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					669.00	33		33																														33							33			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_0	6	1	Preferred Generic	3	4	001000	3	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	005	0	1	01	01	H1045_005_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	5	2	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	.66	20.00		60.00																															50.00							60.00				20.00				.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	5	3	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	1.33	40.00		120.00																															110.00							120.00				40.00				1.29	40.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	5	4	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					914.00	33		33																														33							33			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	012	0	1	02	01	H1045_012_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	012	0	1	02	01	H1045_012_0	5	2	Preferred Brand	1	4	010001	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	012	0	1	02	01	H1045_012_0	5	3	Non-Preferred Brand	1	4	100100	1	1	110		01	100		1	30		90				1			90				30		31					37.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	012	0	1	02	01	H1045_012_0	5	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					417.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	012	0	1	02	01	H1045_012_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	016	0	1	01	01	H1045_016_0	6	3	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	.83	25.00		75.00																															65.00							75.00				25.00				.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	016	0	1	01	01	H1045_016_0	6	2	Preferred Brand	1	4	010001	3	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	016	0	1	01	01	H1045_016_0	6	1	Preferred Generic	1	4	001000	3	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	016	0	1	01	01	H1045_016_0	6	4	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					662.00	33		33																														33							33			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	016	0	1	01	01	H1045_016_0	6	1	Preferred Generic	3	4	001000	3	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	016	0	1	01	01	H1045_016_0	6	2	Preferred Brand	3	4	010001	3	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	018	0	1	01	01	H1045_018_0	5	3	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	.83	25.00		75.00																															65.00							75.00				25.00				.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	5	2	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	5	4	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					629.00	33		33																														33							33			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	023	0	1	01	01	H1045_023_0	4	4	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					770.00	33		33																														33							33			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	023	0	1	01	01	H1045_023_0	4	3	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	023	0	1	01	01	H1045_023_0	4	2	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	023	0	1	01	01	H1045_023_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.20	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	4	2	Non-Preferred Generic	1	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	.23	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					584.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1076	011	0	1	01	01	H1076_011_0	13	1	Preferred Generic	1	4	001010	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1076	011	0	1	01	01	H1076_011_0	13	4	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1076	011	0	1	01	01	H1076_011_0	13	3	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1076	011	0	1	01	01	H1076_011_0	13	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.50	45.00	90.00	90.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	004	0	1	01	01	H1080_004_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	004	0	1	01	01	H1080_004_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	004	0	1	01	01	H1080_004_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	004	0	1	01	01	H1080_004_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	004	0	1	01	01	H1080_004_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					587.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	042	0	1	01	01	H1080_042_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	042	0	1	01	01	H1080_042_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	042	0	1	01	01	H1080_042_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	042	0	1	01	01	H1080_042_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					631.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	042	0	1	01	01	H1080_042_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	043	0	1	01	01	H1080_043_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	043	0	1	01	01	H1080_043_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	043	0	1	01	01	H1080_043_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	043	0	1	01	01	H1080_043_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1080	043	0	1	01	01	H1080_043_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					613.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.00	90.00		270.00																								225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1334.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1099	001	0	1	02	01	H1099_001_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1099	006	0	1	01	01	H1099_006_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.00	90.00		270.00																								225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					981.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1099	014	0	1	01	01	H1099_014_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	014	0	1	01	01	H1099_014_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	014	0	1	01	01	H1099_014_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	014	0	1	01	01	H1099_014_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1205.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	014	0	1	01	01	H1099_014_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.16	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	016	0	1	01	01	H1099_016_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	2.00		6.00																								4.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1099	016	0	1	01	01	H1099_016_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					981.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	016	0	1	01	01	H1099_016_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.00	90.00		270.00																								225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	016	0	1	01	01	H1099_016_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	016	0	1	01	01	H1099_016_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	016	0	1	01	01	H1099_016_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.06	2.00		6.00																								4.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	017	0	1	02	01	H1099_017_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					981.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	017	0	1	02	01	H1099_017_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1099	017	0	1	02	01	H1099_017_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.00	90.00		270.00																								225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	017	0	1	02	01	H1099_017_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	017	0	1	02	01	H1099_017_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.13	4.00		12.00																								8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	017	0	1	02	01	H1099_017_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.13	4.00		12.00																								8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1099	017	0	1	02	01	H1099_017_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1109	001	0	1	01	01	H1109_001_0	7	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1109	001	0	1	01	01	H1109_001_0	7	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1109	001	0	1	01	01	H1109_001_0	7	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1109	001	0	1	01	01	H1109_001_0	7	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1109	001	0	1	01	01	H1109_001_0	7	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1109	001	0	1	01	01	H1109_001_0	7	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1109	005	0	1	01	01	H1109_005_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1109	005	0	1	01	01	H1109_005_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1109	005	0	1	01	01	H1109_005_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1109	005	0	1	01	01	H1109_005_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1109	005	0	1	01	01	H1109_005_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1109	005	0	1	01	01	H1109_005_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1110	001	0	1	04	01	H1110_001_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1110	001	0	1	04	01	H1110_001_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1110	001	0	1	04	01	H1110_001_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1110	001	0	1	04	01	H1110_001_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1110	001	0	1	04	01	H1110_001_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1110	001	0	1	04	01	H1110_001_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1111	002	0	1	01	01	H1111_002_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	002	0	1	01	01	H1111_002_0	7	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					524.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	002	0	1	01	01	H1111_002_0	7	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	002	0	1	01	01	H1111_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	002	0	1	01	01	H1111_002_0	7	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.23	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	7	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.40	42.00		126.00																															116.00							126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	7	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	7	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					479.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					1.45	45.00	90.00	135.00												.48	15.00	30.00	30.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.64	20.00	40.00	60.00												.06	2.00	4.00	4.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					2.90	90.00	180.00	270.00												1.29	40.00	80.00	80.00				2.90	90.00	180.00	270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	02	01	H1112_027_0	5	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	02	01	H1112_027_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	02	01	H1112_027_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.41	75.00	150.00	225.00					2.90	90.00	180.00	270.00												2.41	75.00	150.00	150.00				2.90	90.00	180.00	270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	02	01	H1112_027_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	02	01	H1112_027_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.70	22.00	44.00	66.00												.48	15.00	30.00	30.00				.70	22.00	44.00	66.00				22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1170	002	0	1	01	01	H1170_002_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				30		90	2	30		90				30		31									.16	5.00		15.00					.33	10.00		30.00					.16	5.00		10.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	002	0	1	01	01	H1170_002_0	6	2	Non-Preferred Generic	3	4	000100	1	2		110	01	110		1				30		90	2	30		90				30		31									.33	10.00		30.00					.66	20.00		60.00					.33	10.00		20.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	002	0	1	01	01	H1170_002_0	6	6	Vaccines	3	4	000001	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	002	0	1	01	01	H1170_002_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	2	30		90				30		31									.16	5.00		15.00					.33	10.00		30.00					.16	5.00		10.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				30		90	2	30		90				30		31									.33	10.00		30.00					.66	20.00		60.00					.33	10.00		20.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	2	30		90				30		31									1.46	44.00		132.00					1.50	45.00		135.00					1.46	44.00		88.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				30		90	2	30		90				30		31									2.50	75.00		225.00					2.83	85.00		255.00					2.50	75.00		150.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	6	5	Specialty Tier	1	4	100001	1	1		110	01	110		1				30		90	2	30		90				30		31													574.00	25		25					574.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	6	6	Vaccines	1	4	000001	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	6	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	2	30		90				30		31									1.46	44.00		132.00					1.50	45.00		135.00					1.46	44.00		88.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	6	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	2	30		90				30		31									2.50	75.00		225.00					2.83	85.00		255.00					2.50	75.00		150.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	6	5	Specialty Tier	1	3	100001	1	1		110	01	110		1				30		90	2	30		90				30		31													531.00	25		25					531.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	6	6	Vaccines	1	3	000001	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	6	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	2	30		90				30		31									0.46	14.00		42.00					1.00	30.00		90.00					.46	14.00		28.00																		30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	6	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	2	30		90				30		31									.16	5.00		15.00					.33	10.00		30.00					.16	5.00		10.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	4	5	Specialty Tier	1	4	100001	1	1		110	01	110		1				30		90	2	30		90				30		31													591.00	25		25					591.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	4	6	Vaccines	1	4	000001	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	4	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				30		90	2	30		90				30		31									.23	7.00		21.00					.33	10.00		30.00					.23	7.00		14.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	009	0	1	01	01	H1170_009_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01	110		1				30		90	2	30		90				30		31									.33	10.00		30.00					.66	20.00		60.00					.33	10.00		20.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	009	0	1	01	01	H1170_009_0	4	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	2	30		90				30		31									.23	7.00		21.00					.33	10.00		30.00					.23	7.00		14.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				30		90	2	30		90				30		31									.33	10.00		30.00					.66	20.00		60.00					.33	10.00		20.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				30		90	2	30		90				30		31									2.50	75.00		225.00					2.83	85.00		255.00					2.50	75.00		150.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	4	6	Vaccines	3	4	000001	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	009	0	1	01	01	H1170_009_0	4	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	2	30		90				30		31									1.46	44.00		132.00					1.50	45.00		135.00					1.46	44.00		88.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1216	001	0	1	02	01	H1216_001_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1216	001	0	1	02	01	H1216_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.70	22.00	44.00	66.00												.48	15.00	30.00	30.00				.70	22.00	44.00	66.00				22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1216	001	0	1	02	01	H1216_001_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.93	29.00	58.00	87.00					1.25	39.00	78.00	117.00												.93	29.00	58.00	58.00				1.25	39.00	78.00	117.00				39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1216	001	0	1	02	01	H1216_001_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.22	69.00	138.00	207.00					2.70	84.00	168.00	252.00												2.22	69.00	138.00	138.00				2.70	84.00	168.00	252.00				84.00				2.70	84.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1216	001	0	1	02	01	H1216_001_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1216	003	0	1	01	01	H1216_003_0	4	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.32	10.00	20.00	30.00												0.00	0.00	0.00	0.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1216	003	0	1	01	01	H1216_003_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.64	20.00	40.00	60.00												.32	10.00	20.00	20.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1216	003	0	1	01	01	H1216_003_0	4	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.64	20.00	40.00	60.00					1.45	45.00	90.00	135.00												.64	20.00	40.00	40.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1216	003	0	1	01	01	H1216_003_0	4	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					3.06	95.00	190.00	285.00												1.93	60.00	120.00	120.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1216	003	0	1	01	01	H1216_003_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1230	001	0	1	01	01	H1230_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.20	6.00		18.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	6	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	001	0	1	01	01	H1230_001_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	001	0	1	01	01	H1230_001_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	6	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					564.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	2.50	75.00		225.00																					2.50	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.20	6.00		18.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.20	6.00		18.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	4	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	4	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	4	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					744.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	2.50	75.00		225.00																					2.50	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.20	6.00		18.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	005	0	1	01	01	H1230_005_0	5	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	005	0	1	01	01	H1230_005_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	005	0	1	01	01	H1230_005_0	5	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	005	0	1	01	01	H1230_005_0	5	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	005	0	1	01	01	H1230_005_0	5	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					617.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	005	0	1	01	01	H1230_005_0	5	6	Vaccines	1	3	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	006	0	1	01	01	H1230_006_0	4	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	006	0	1	01	01	H1230_006_0	4	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					602.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	006	0	1	01	01	H1230_006_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.20	6.00		18.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	006	0	1	01	01	H1230_006_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	006	0	1	01	01	H1230_006_0	4	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	006	0	1	01	01	H1230_006_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	006	0	1	01	01	H1230_006_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	2.50	75.00		225.00																					2.50	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	006	0	1	01	01	H1230_006_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	006	0	1	01	01	H1230_006_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.20	6.00		18.00																					.20	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1264	004	0	1	02	01	H1264_004_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					2.41	75.00	150.00	225.00												1.93	60.00	120.00	120.00				2.41	75.00	150.00	225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_0	5	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.96	30.00	60.00	90.00					1.29	40.00	80.00	120.00												.96	30.00	60.00	60.00				1.29	40.00	80.00	120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.70	22.00	44.00	66.00												.48	15.00	30.00	30.00				.70	22.00	44.00	66.00				22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.61	50.00	100.00	150.00					3.06	95.00	190.00	285.00												1.61	50.00	100.00	100.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.64	20.00	40.00	60.00					1.45	45.00	90.00	135.00												.64	20.00	40.00	40.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.22	7.00	14.00	21.00					.64	20.00	40.00	60.00												.22	7.00	14.00	14.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.32	10.00	20.00	30.00												0.00	0.00	0.00	0.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	6	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.70	22.00	44.00	66.00												.48	15.00	30.00	30.00				.70	22.00	44.00	66.00				22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	6	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.96	30.00	60.00	90.00					1.29	40.00	80.00	120.00												.96	30.00	60.00	60.00				1.29	40.00	80.00	120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					2.41	75.00	150.00	225.00												1.93	60.00	120.00	120.00				2.41	75.00	150.00	225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	6	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.32	10.00	20.00	30.00												0.00	0.00	0.00	0.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.64	20.00	40.00	60.00												.32	10.00	20.00	20.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	6	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.64	20.00	40.00	60.00					1.45	45.00	90.00	135.00												.64	20.00	40.00	40.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	6	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.77	55.00	110.00	165.00					3.06	95.00	190.00	285.00												1.77	55.00	110.00	110.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	6	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					475.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					475.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1291	001	0	1	09	04	H1291_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1291	001	0	1	09	04	H1291_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1291	001	0	1	09	04	H1291_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1291	001	0	1	09	04	H1291_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1291	001	0	1	09	04	H1291_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.30	9.00		27.00																												0.30	9.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1291	001	0	1	09	04	H1291_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1291	001	0	1	09	04	H1291_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1291	001	0	1	09	04	H1291_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1291	001	0	1	09	04	H1291_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1291	001	0	1	09	04	H1291_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.30	9.00		27.00																												0.30	9.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	001	0	1	04	01	H1302_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.10	93.00		279.00																								279.00																		93.00				3.00	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	001	0	1	04	01	H1302_001_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.43	43.00		129.00																								129.00																		43.00				1.39	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	001	0	1	04	01	H1302_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	001	0	1	04	01	H1302_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								12.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	001	0	1	04	01	H1302_001_0	5	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	30							30						30		31					810.00	27																							27																			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	006	0	1	04	01	H1302_006_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								12.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	006	0	1	04	01	H1302_006_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	006	0	1	04	01	H1302_006_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.43	43.00		129.00																								129.00																		43.00				1.39	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	006	0	1	04	01	H1302_006_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.10	93.00		279.00																								279.00																		93.00				3.00	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	006	0	1	04	01	H1302_006_0	5	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	30							30						30		31					810.00	27																							27																			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	001	0	1	04	01	H1303_001_0	6	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					513.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	001	0	1	04	01	H1303_001_0	6	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	001	0	1	04	01	H1303_001_0	6	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	001	0	1	04	01	H1303_001_0	6	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	001	0	1	04	01	H1303_001_0	6	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	007	0	1	04	01	H1303_007_0	6	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	007	0	1	04	01	H1303_007_0	6	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	007	0	1	04	01	H1303_007_0	6	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	007	0	1	04	01	H1303_007_0	6	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1303	007	0	1	04	01	H1303_007_0	6	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					513.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	002	0	1	04	01	H1304_002_0	15	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	002	0	1	04	01	H1304_002_0	15	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					631.00	29																							29																			29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	002	0	1	04	01	H1304_002_0	15	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	002	0	1	04	01	H1304_002_0	15	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	002	0	1	04	01	H1304_002_0	15	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.33	10.00		30.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	12	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					701.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	12	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	12	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1304	004	0	1	04	01	H1304_004_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	009	0	1	04	01	H1304_009_0	12	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.33	10.00		30.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	009	0	1	04	01	H1304_009_0	12	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					627.00	29																							29																			29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	009	0	1	04	01	H1304_009_0	12	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	009	0	1	04	01	H1304_009_0	12	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	009	0	1	04	01	H1304_009_0	12	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	010	0	1	04	01	H1304_010_0	12	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					700.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	010	0	1	04	01	H1304_010_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	010	0	1	04	01	H1304_010_0	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	010	0	1	04	01	H1304_010_0	12	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1304	010	0	1	04	01	H1304_010_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	010	0	1	04	01	H1304_010_0	12	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	001	0	1	01	01	H1350_001_0	3	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.03	31.00		93.00																								93.00																		31.00				1.00	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	001	0	1	01	01	H1350_001_0	3	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	001	0	1	01	01	H1350_001_0	3	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								12.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	001	0	1	01	01	H1350_001_0	3	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	30							30						30		31					990.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	001	0	1	01	01	H1350_001_0	3	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								12.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1350	001	0	1	01	01	H1350_001_0	3	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1350	001	0	1	01	01	H1350_001_0	3	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.33	70.00		210.00																								210.00																		70.00				2.26	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	010	0	1	01	01	H1350_010_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.03	31.00		93.00																								93.00																		31.00				1.00	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	010	0	1	01	01	H1350_010_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.33	70.00		210.00																								210.00																		70.00				2.26	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	010	0	1	01	01	H1350_010_0	4	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	30							30						30		31					990.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	010	0	1	01	01	H1350_010_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								12.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	010	0	1	01	01	H1350_010_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	012	0	1	02	01	H1350_012_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								12.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	012	0	1	02	01	H1350_012_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.03	31.00		93.00																								93.00																		31.00				1.00	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	012	0	1	02	01	H1350_012_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.33	70.00		210.00																								210.00																		70.00				2.26	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	012	0	1	02	01	H1350_012_0	4	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	30							30						30		31					990.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	012	0	1	02	01	H1350_012_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	11	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.00	0.00	0.00	0.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	11	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.20	6.00	12.00	18.00					0.33	10.00	20.00	30.00					0.33	10.00	20.00	25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	11	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.50	45.00	90.00	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	11	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.00	90.00	180.00	270.00					3.00	90.00	180.00	270.00					3.00	90.00	180.00	225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	11	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													600.00	33	33	33					600.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	8	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.00	0.00	0.00	0.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	8	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													600.00	33	33	33					600.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	8	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.50	45.00	90.00	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	8	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.20	6.00	12.00	18.00					0.33	10.00	20.00	30.00					0.33	10.00	20.00	25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.00	90.00	180.00	270.00					3.00	90.00	180.00	270.00					3.00	90.00	180.00	225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	003	0	1	04	01	H1365_003_0	10	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.00	0.00	0.00	0.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	003	0	1	04	01	H1365_003_0	10	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													600.00	33	33	33					600.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	003	0	1	04	01	H1365_003_0	10	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.20	6.00	12.00	18.00					0.33	10.00	20.00	30.00					0.33	10.00	20.00	25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	003	0	1	04	01	H1365_003_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.50	45.00	90.00	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	003	0	1	04	01	H1365_003_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.00	90.00	180.00	270.00					3.00	90.00	180.00	270.00					3.00	90.00	180.00	225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1367	002	0	1	01	01	H1367_002_0	10	4	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31						25	25	25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1367	002	0	1	01	01	H1367_002_0	10	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1367	002	0	1	01	01	H1367_002_0	10	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.23	7.00	14.00	21.00																								17.50																		7.00				0.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1367	002	0	1	01	01	H1367_002_0	10	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	013	0	1	01	01	H1406_013_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	013	0	1	01	01	H1406_013_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	013	0	1	01	01	H1406_013_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	013	0	1	01	01	H1406_013_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1406	013	0	1	01	01	H1406_013_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	022	0	1	01	01	H1406_022_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	022	0	1	01	01	H1406_022_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	022	0	1	01	01	H1406_022_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	022	0	1	01	01	H1406_022_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1406	022	0	1	01	01	H1406_022_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	026	0	1	01	01	H1406_026_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	026	0	1	01	01	H1406_026_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	026	0	1	01	01	H1406_026_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	026	0	1	01	01	H1406_026_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1406	026	0	1	01	01	H1406_026_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	027	0	1	01	01	H1406_027_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	027	0	1	01	01	H1406_027_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1406	027	0	1	01	01	H1406_027_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	027	0	1	01	01	H1406_027_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	027	0	1	01	01	H1406_027_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	027	0	1	01	01	H1406_027_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	027	0	1	01	01	H1406_027_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	027	0	1	01	01	H1406_027_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	027	0	1	01	01	H1406_027_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	027	0	1	01	01	H1406_027_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	028	0	1	01	01	H1406_028_0	9	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	028	0	1	01	01	H1406_028_0	9	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	028	0	1	01	01	H1406_028_0	9	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	028	0	1	01	01	H1406_028_0	9	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	028	0	1	01	01	H1406_028_0	9	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1406	028	0	1	01	01	H1406_028_0	9	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	028	0	1	01	01	H1406_028_0	9	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	028	0	1	01	01	H1406_028_0	9	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	028	0	1	01	01	H1406_028_0	9	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	028	0	1	01	01	H1406_028_0	9	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	029	0	1	01	01	H1406_029_0	10	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	029	0	1	01	01	H1406_029_0	10	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	029	0	1	01	01	H1406_029_0	10	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	029	0	1	01	01	H1406_029_0	10	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	029	0	1	01	01	H1406_029_0	10	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	029	0	1	01	01	H1406_029_0	10	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1406	029	0	1	01	01	H1406_029_0	10	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	029	0	1	01	01	H1406_029_0	10	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	029	0	1	01	01	H1406_029_0	10	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	029	0	1	01	01	H1406_029_0	10	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	030	0	1	01	01	H1406_030_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	030	0	1	01	01	H1406_030_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	030	0	1	01	01	H1406_030_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	030	0	1	01	01	H1406_030_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	030	0	1	01	01	H1406_030_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	030	0	1	01	01	H1406_030_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	030	0	1	01	01	H1406_030_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	030	0	1	01	01	H1406_030_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	030	0	1	01	01	H1406_030_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	030	0	1	01	01	H1406_030_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1406	031	0	1	01	01	H1406_031_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	031	0	1	01	01	H1406_031_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	031	0	1	01	01	H1406_031_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	031	0	1	01	01	H1406_031_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.43	13.00		39.00																												0.43	13.00		0.00				0.43	13.00		39.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	031	0	1	01	01	H1406_031_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.50	75.00	150.00	225.00																					2.50	75.00		215.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	3	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					499.12	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00		6.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00		6.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.32	10.00	20.00	30.00												0.00	0.00	0.00	0.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.61	50.00	100.00	150.00					3.06	95.00	190.00	285.00												1.61	50.00	100.00	100.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.64	20.00	40.00	60.00					1.45	45.00	90.00	135.00												.64	20.00	40.00	40.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.29	9.00	18.00	27.00					.64	20.00	40.00	60.00												.29	9.00	18.00	18.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.22	69.00	138.00	207.00					2.70	84.00	168.00	252.00												2.22	69.00	138.00	138.00				2.70	84.00	168.00	252.00				84.00				2.70	84.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	5	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.41	13.00	26.00	39.00					.64	20.00	40.00	60.00												.41	13.00	26.00	26.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	019	0	1	01	01	H1416_019_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													743.71	33							743.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	019	0	1	01	01	H1416_019_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.25	70.00	140.00	210.00					3.06	95.00	190.00	285.00												2.25	70.00	140.00	140.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	019	0	1	01	01	H1416_019_0	5	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	019	0	1	01	01	H1416_019_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.09	3.00	6.00	9.00					.19	6.00	12.00	18.00												.09	3.00	6.00	0.00				.19	6.00	12.00	18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	019	0	1	01	01	H1416_019_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.80	25.00	50.00	75.00												.48	15.00	30.00	30.00				.80	25.00	50.00	75.00				25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	002	0	1	04	01	H1417_002_0	11	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	27		27					1.00	27		27					27		27																	27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	002	0	1	04	01	H1417_002_0	11	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									0.00	0.00		0.00					.26	8.00		24.00					.26	8.00		24.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	002	0	1	04	01	H1417_002_0	11	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									1.10	33.00		66.00					1.10	33.00		99.00					1.10	33.00		99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	002	0	1	04	01	H1417_002_0	11	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	002	0	1	04	01	H1417_002_0	11	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.17	95.00		190.00					3.17	95.00		285.00					3.17	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	004	0	1	04	01	H1417_004_0	11	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									0.00	0.00		0.00					.26	8.00		24.00					.26	8.00		24.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	004	0	1	04	01	H1417_004_0	11	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									1.10	33.00		66.00					1.10	33.00		99.00					1.10	33.00		99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	004	0	1	04	01	H1417_004_0	11	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	004	0	1	04	01	H1417_004_0	11	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.17	95.00		190.00					3.17	95.00		285.00					3.17	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	004	0	1	04	01	H1417_004_0	11	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	27		27					1.00	27		27					27		27																	27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	002	0	1	04	01	H1418_002_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	002	0	1	04	01	H1418_002_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	002	0	1	04	01	H1418_002_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	002	0	1	04	01	H1418_002_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1418	002	0	1	04	01	H1418_002_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1418	002	0	1	04	01	H1418_002_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	002	0	1	04	01	H1418_002_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	002	0	1	04	01	H1418_002_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	002	0	1	04	01	H1418_002_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	002	0	1	04	01	H1418_002_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	007	0	1	04	01	H1418_007_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1418	007	0	1	04	01	H1418_007_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	007	0	1	04	01	H1418_007_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	007	0	1	04	01	H1418_007_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	007	0	1	04	01	H1418_007_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	007	0	1	04	01	H1418_007_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	007	0	1	04	01	H1418_007_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1418	007	0	1	04	01	H1418_007_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	007	0	1	04	01	H1418_007_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	007	0	1	04	01	H1418_007_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	008	0	1	04	01	H1418_008_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	008	0	1	04	01	H1418_008_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	008	0	1	04	01	H1418_008_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	008	0	1	04	01	H1418_008_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	008	0	1	04	01	H1418_008_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1418	008	0	1	04	01	H1418_008_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1418	008	0	1	04	01	H1418_008_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	008	0	1	04	01	H1418_008_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	008	0	1	04	01	H1418_008_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	008	0	1	04	01	H1418_008_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1419	001	0	1	01	01	H1419_001_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1419	001	0	1	01	01	H1419_001_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1419	001	0	1	01	01	H1419_001_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1419	001	0	1	01	01	H1419_001_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					44.71	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1419	001	0	1	01	01	H1419_001_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1419	001	0	1	01	01	H1419_001_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					85.77	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1444	001	0	1	01	01	H1444_001_0	5	1	Preferred Generic	1	4	001000	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1444	001	0	1	01	01	H1444_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1444	001	0	1	01	01	H1444_001_0	5	3	Preferred Brand	1	4	000001	1	1	010		01			1	30													30		31					39.33	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1444	001	0	1	01	01	H1444_001_0	5	2	Non-Preferred Generic	3	4	000100	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1444	001	0	1	01	01	H1444_001_0	5	5	Specialty Tier	1	4	000010	1	1	010		01			1	30													30		31						25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1444	001	0	1	01	01	H1444_001_0	5	1	Preferred Generic	3	4	001000	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1444	001	0	1	01	01	H1444_001_0	5	4	Non-Preferred Brand	1	4	100000	1	1	010		01			1	30													30		31					41.85	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	11	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.17	95.00		190.00					3.17	95.00		285.00					3.17	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	11	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	11	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									1.10	33.00		66.00					1.10	33.00		99.00					1.10	33.00		99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	11	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									0.00	0.00		0.00					.26	8.00		24.00					.26	8.00		24.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	11	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	25		25					1.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	10	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.17	95.00		190.00					3.17	95.00		285.00					3.17	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	10	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	10	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									1.10	33.00		66.00					1.10	33.00		99.00					1.10	33.00		99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	10	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									0.00	0.00		0.00					.26	8.00		24.00					.26	8.00		24.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	10	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	25		25					1.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1468	007	0	1	01	01	H1468_007_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1468	007	0	1	01	01	H1468_007_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1468	007	0	1	01	01	H1468_007_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1468	007	0	1	01	01	H1468_007_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1468	007	0	1	01	01	H1468_007_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	001	0	1	04	01	H1509_001_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					555.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	001	0	1	04	01	H1509_001_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	001	0	1	04	01	H1509_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	001	0	1	04	01	H1509_001_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	001	0	1	04	01	H1509_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	007	0	1	04	01	H1509_007_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	007	0	1	04	01	H1509_007_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	007	0	1	04	01	H1509_007_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	007	0	1	04	01	H1509_007_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	007	0	1	04	01	H1509_007_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					612.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	009	0	1	04	01	H1509_009_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	009	0	1	04	01	H1509_009_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	009	0	1	04	01	H1509_009_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	009	0	1	04	01	H1509_009_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					597.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	009	0	1	04	01	H1509_009_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	010	0	1	04	01	H1509_010_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	010	0	1	04	01	H1509_010_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.23	7.00		21.00																															14.00							21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	010	0	1	04	01	H1509_010_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.00	90.00		270.00																															260.00							270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	010	0	1	04	01	H1509_010_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.33	40.00		120.00																															110.00							120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1509	010	0	1	04	01	H1509_010_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					670.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	001	0	1	04	01	H1510_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	001	0	1	04	01	H1510_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	001	0	1	04	01	H1510_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	001	0	1	04	01	H1510_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	001	0	1	04	01	H1510_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	001	0	1	04	01	H1510_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	001	0	1	04	01	H1510_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1510	001	0	1	04	01	H1510_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1510	001	0	1	04	01	H1510_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	001	0	1	04	01	H1510_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	004	0	1	04	01	H1510_004_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1510	004	0	1	04	01	H1510_004_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	004	0	1	04	01	H1510_004_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	004	0	1	04	01	H1510_004_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	004	0	1	04	01	H1510_004_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1510	004	0	1	04	01	H1510_004_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	004	0	1	04	01	H1510_004_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	004	0	1	04	01	H1510_004_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	004	0	1	04	01	H1510_004_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	004	0	1	04	01	H1510_004_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	005	0	1	04	01	H1510_005_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1510	005	0	1	04	01	H1510_005_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	005	0	1	04	01	H1510_005_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	005	0	1	04	01	H1510_005_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	005	0	1	04	01	H1510_005_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	005	0	1	04	01	H1510_005_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	005	0	1	04	01	H1510_005_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	005	0	1	04	01	H1510_005_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	005	0	1	04	01	H1510_005_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1510	005	0	1	04	01	H1510_005_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	008	0	1	04	01	H1510_008_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	008	0	1	04	01	H1510_008_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	008	0	1	04	01	H1510_008_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	008	0	1	04	01	H1510_008_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1510	008	0	1	04	01	H1510_008_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	008	0	1	04	01	H1510_008_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1510	008	0	1	04	01	H1510_008_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	008	0	1	04	01	H1510_008_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	008	0	1	04	01	H1510_008_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	008	0	1	04	01	H1510_008_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1517	004	0	1	04	01	H1517_004_0	6	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1517	004	0	1	04	01	H1517_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.12	4.00	8.00	12.00					.26	9.00	18.00	27.00					.12	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1517	004	0	1	04	01	H1517_004_0	6	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1517	004	0	1	04	01	H1517_004_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.03	1.00	2.00	3.00					.18	6.00	12.00	18.00					.03	1.00	2.00	2.00																		6.00				.18	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1517	004	0	1	04	01	H1517_004_0	6	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.00	33	33	33					61.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1517	004	0	1	04	01	H1517_004_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1517	005	0	1	04	01	H1517_005_0	6	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.00	33	33	33					61.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1517	005	0	1	04	01	H1517_005_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.41	14.00	28.00	42.00					.56	19.00	38.00	57.00					.41	14.00	28.00	28.00																		19.00				.56	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1517	005	0	1	04	01	H1517_005_0	6	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.12	4.00	8.00	12.00					.26	9.00	18.00	27.00					.12	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1517	005	0	1	04	01	H1517_005_0	6	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1517	005	0	1	04	01	H1517_005_0	6	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1517	005	0	1	04	01	H1517_005_0	6	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	6	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	6	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.23	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	6	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					590.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	6	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.00	90.00		270.00																															260.00							270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	6	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1595	002	0	1	04	01	H1595_002_0	7	1	Generic	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.20	6.00	12.00	15.00																					0.20	6.00	12.00	15.00																		6.00				0.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1595	002	0	1	04	01	H1595_002_0	7	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.16	40.00	80.00	100.00																					1.16	40.00	80.00	100.00																		40.00				1.12	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1595	002	0	1	04	01	H1595_002_0	7	3	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.33	95.00	190.00	237.50																					2.33	95.00	190.00	237.50																		95.00				2.25	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1595	002	0	1	04	01	H1595_002_0	7	4	Specialty Tier	1	4	110001	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	33	33	33																					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1595	003	0	1	04	01	H1595_003_0	7	1	Generic	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.23	7.00	14.00	17.50																					.23	7.00	14.00	17.50																		7.00				.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1595	003	0	1	04	01	H1595_003_0	7	2	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	112.50																					1.50	45.00	90.00	112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1595	003	0	1	04	01	H1595_003_0	7	3	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.17	95.00	190.00	237.50																					3.17	95.00	190.00	237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1595	003	0	1	04	01	H1595_003_0	7	4	Specialty Tier	1	3	110001	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1607	001	0	1	04	01	H1607_001_0	7	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1607	001	0	1	04	01	H1607_001_0	7	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.50	17.00	34.00	51.00					.65	22.00	44.00	66.00					.50	17.00	34.00	34.00																		22.00				.65	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1607	001	0	1	04	01	H1607_001_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1607	001	0	1	04	01	H1607_001_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1607	001	0	1	04	01	H1607_001_0	7	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1607	001	0	1	04	01	H1607_001_0	7	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													48.00	33	33	33					48.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	10	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					2.93	88.00	176.00	264.00					2.83	85.00	170.00	255.00																		88.00				2.83	88.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	10	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.10	3.00	6.00	9.00					.23	7.00	14.00	21.00					.10	3.00	6.00	9.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	10	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.23	7.00	14.00	21.00					.33	10.00	20.00	30.00					.23	7.00	14.00	21.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	8	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.66	80.00	160.00	240.00					2.76	83.00	166.00	249.00					2.66	80.00	160.00	240.00																		83.00				2.67	83.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.43	43.00	86.00	129.00					1.33	40.00	80.00	120.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.13	4.00	8.00	12.00					.23	7.00	14.00	21.00					.13	4.00	8.00	12.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00					.06	2.00	4.00	6.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	8	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.66	80.00	160.00	240.00					2.76	83.00	166.00	249.00					2.66	80.00	160.00	240.00																		83.00				2.67	83.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00					.06	2.00	4.00	6.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.13	4.00	8.00	12.00					.23	7.00	14.00	21.00					.13	4.00	8.00	12.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.43	43.00	86.00	129.00					1.33	40.00	80.00	120.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	8	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.66	80.00	160.00	240.00					2.76	83.00	166.00	249.00					2.66	80.00	160.00	240.00																		83.00				2.67	83.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.43	43.00	86.00	129.00					1.33	40.00	80.00	120.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.13	4.00	8.00	12.00					.23	7.00	14.00	21.00					.13	4.00	8.00	12.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00					.06	2.00	4.00	6.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	9	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					2.93	88.00	176.00	264.00					2.83	85.00	170.00	255.00																		88.00				2.83	88.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.10	3.00	6.00	9.00					.23	7.00	14.00	21.00					.10	3.00	6.00	9.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	9	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.23	7.00	14.00	21.00					.33	10.00	20.00	30.00					.23	7.00	14.00	21.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	9	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00					.06	2.00	4.00	6.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.13	4.00	8.00	12.00					.23	7.00	14.00	21.00					.13	4.00	8.00	12.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.43	43.00	86.00	129.00					1.33	40.00	80.00	120.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.66	80.00	160.00	240.00					2.76	83.00	166.00	249.00					2.66	80.00	160.00	240.00																		83.00				2.67	83.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	010	0	1	01	01	H1609_010_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00					.06	2.00	4.00	6.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	010	0	1	01	01	H1609_010_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	010	0	1	01	01	H1609_010_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.66	80.00	160.00	240.00					2.76	83.00	166.00	249.00					2.66	80.00	160.00	240.00																		83.00				2.67	83.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	010	0	1	01	01	H1609_010_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.43	43.00	86.00	129.00					1.33	40.00	80.00	120.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	010	0	1	01	01	H1609_010_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.13	4.00	8.00	12.00					.23	7.00	14.00	21.00					.13	4.00	8.00	12.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	7	1	Generic	1	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	.27	8.00		24.00																					.27	8.00		16.00																		8.00				.26	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.33	40.00		120.00																					1.33	40.00		80.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	7	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.67	80.00		240.00																					2.67	80.00		160.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	7	4	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				1	30		90				30		31					200.00	33		33																					33		33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	8	1	Generic	1	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	.27	8.00		24.00																					.27	8.00		16.00																		8.00				.26	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.33	40.00		120.00																					1.33	40.00		80.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	8	4	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				1	30		90				30		31					200.00	33		33																					33		33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.67	80.00		240.00																					2.67	80.00		160.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	9	1	Generic	1	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	9	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.17	95.00		285.00																					3.17	95.00		190.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	9	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	9	4	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				1	30		90				30		31					200.00	33		33																					33		33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				1	30		90				30		31	.10	3.00	6.00	9.00																					.08	2.50		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand										1		
H1660	001	0	1	01	01	H1660_001_0	7	4	Non-Preferred Brand	1	4	100000	1	1	111		01	110		1	30	60	90				1	30		90				30		31					44.19	40	40	40																					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H1660	001	0	1	01	01	H1660_001_0	7	3	Preferred Brand	1	4	000001	1	1	111		01	110		1	30	60	90				1	30		90				30		31					39.60	25	25	25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H1660	001	0	1	01	01	H1660_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				1	30		90				30		31	0.33	10.00	20.00	30.00																					.30	9.00		27.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H1660	001	0	1	01	01	H1660_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				1	30		90				30		31	0.10	3.00	6.00	9.00																					.08	2.50		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H1660	001	0	1	01	01	H1660_001_0	7	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				1	30		90				30		31	.33	10.00	20.00	30.00																					0.30	9.00		27.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand										1		
H1660	004	0	1	01	01	H1660_004_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				1	30		90				30		31	.10	3.00	6.00	9.00																					.08	2.50		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand										1		
H1660	004	0	1	01	01	H1660_004_0	7	4	Non-Preferred Brand	1	4	100000	1	1	111		01	110		1	30	60	90				1	30		90				30		31					44.19	40	40	40																					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H1660	004	0	1	01	01	H1660_004_0	7	3	Preferred Brand	1	4	000001	1	1	111		01	110		1	30	60	90				1	30		90				30		31					39.60	25	25	25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H1660	004	0	1	01	01	H1660_004_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				1	30		90				30		31	0.33	10.00	20.00	30.00																					.30	9.00		27.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H1660	004	0	1	01	01	H1660_004_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				1	30		90				30		31	0.10	3.00	6.00	9.00																					.08	2.50		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H1660	004	0	1	01	01	H1660_004_0	7	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				1	30		90				30		31	.33	10.00	20.00	30.00																					0.30	9.00		27.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand										1		
H1660	005	0	1	01	01	H1660_005_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				1	30		90				30		31	0.10	3.00	6.00	9.00																					.08	2.50		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H1660	005	0	1	01	01	H1660_005_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				1	30		90				30		31	0.33	10.00	20.00	30.00																					.30	9.00		27.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H1660	005	0	1	01	01	H1660_005_0	9	3	Preferred Brand	1	4	000001	1	1	111		01	110		1	30	60	90				1	30		90				30		31					37.70	25	25	25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H1660	005	0	1	01	01	H1660_005_0	9	4	Non-Preferred Brand	1	4	100000	1	1	111		01	110		1	30	60	90				1	30		90				30		31					42.09	40	40	40																					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H1660	005	0	1	01	01	H1660_005_0	9	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				1	30		90				30		31	.10	3.00	6.00	9.00																					.08	2.50		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand										1		
H1660	005	0	1	01	01	H1660_005_0	9	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				1	30		90				30		31	.33	10.00	20.00	30.00																					0.30	9.00		27.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand										1		
H1666	001	0	1	04	01	H1666_001_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	001	0	1	04	01	H1681_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.06	2.00		6.00																												0.06	2.00		0.00				0.06	2.00		6.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	001	0	1	04	01	H1681_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	001	0	1	04	01	H1681_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1681	001	0	1	04	01	H1681_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1681	001	0	1	04	01	H1681_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1681	001	0	1	04	01	H1681_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1681	001	0	1	04	01	H1681_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	001	0	1	04	01	H1681_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.50	75.00		225.00																												2.50	75.00		215.00				2.50	75.00		225.00				75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	001	0	1	04	01	H1681_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	001	0	1	04	01	H1681_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.06	2.00		6.00																												0.06	2.00		0.00				0.06	2.00		6.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1681	002	0	1	04	01	H1681_002_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	002	0	1	04	01	H1681_002_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	002	0	1	04	01	H1681_002_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.43	13.00		39.00																												0.43	13.00		0.00				0.43	13.00		39.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	002	0	1	04	01	H1681_002_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	002	0	1	04	01	H1681_002_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	005	0	1	04	01	H1681_005_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	005	0	1	04	01	H1681_005_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	005	0	1	04	01	H1681_005_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	005	0	1	04	01	H1681_005_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	005	0	1	04	01	H1681_005_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1681	005	0	1	04	01	H1681_005_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1681	005	0	1	04	01	H1681_005_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1681	005	0	1	04	01	H1681_005_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1681	005	0	1	04	01	H1681_005_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1681	005	0	1	04	01	H1681_005_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	006	0	1	04	01	H1681_006_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1681	006	0	1	04	01	H1681_006_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1681	006	0	1	04	01	H1681_006_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1681	006	0	1	04	01	H1681_006_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1681	006	0	1	04	01	H1681_006_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1681	006	0	1	04	01	H1681_006_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	006	0	1	04	01	H1681_006_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	006	0	1	04	01	H1681_006_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	006	0	1	04	01	H1681_006_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1681	006	0	1	04	01	H1681_006_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	001	0	1	01	01	H1692_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	001	0	1	01	01	H1692_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	180.00	270.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	001	0	1	01	01	H1692_001_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	001	0	1	01	01	H1692_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.10	33.00	66.00	99.00					0.66	20.00	40.00	50.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	001	0	1	01	01	H1692_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.33	10.00	20.00	30.00					0.13	4.00	8.00	10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.33	10.00	20.00	30.00					0.13	4.00	8.00	10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.00	30.00	60.00	90.00					0.66	20.00	40.00	50.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	180.00	270.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1716	001	0	1	04	01	H1716_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1716	001	0	1	04	01	H1716_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1716	001	0	1	04	01	H1716_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1716	001	0	1	04	01	H1716_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1716	001	0	1	04	01	H1716_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	006	0	1	04	01	H1716_006_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1716	006	0	1	04	01	H1716_006_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1716	006	0	1	04	01	H1716_006_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1716	006	0	1	04	01	H1716_006_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.43	13.00		39.00																												0.43	13.00		0.00				0.43	13.00		39.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1716	006	0	1	04	01	H1716_006_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1716	006	0	1	04	01	H1716_006_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	006	0	1	04	01	H1716_006_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	006	0	1	04	01	H1716_006_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	006	0	1	04	01	H1716_006_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.43	13.00		39.00																												0.43	13.00		0.00				0.43	13.00		39.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	006	0	1	04	01	H1716_006_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	020	0	1	04	01	H1716_020_0	4	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.00	90.00		270.00					3.16	95.00		285.00												3.00	90.00		260.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1716	020	0	1	04	01	H1716_020_0	4	3	Preferred Brand	3	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	16		16					35.00	25		25												16		16					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1716	020	0	1	04	01	H1716_020_0	4	2	Non-Preferred Generic	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.33	10.00		30.00												0.10	3.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1716	020	0	1	04	01	H1716_020_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.33	10.00		30.00												0.10	3.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	020	0	1	04	01	H1716_020_0	4	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													15.00	16		16					25.00	25		25												16		16					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	020	0	1	04	01	H1716_020_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	27							1.00	27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	020	0	1	04	01	H1716_020_0	4	5	Specialty Tier	3	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	27							1.00	27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1716	020	0	1	04	01	H1716_020_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													34.00	30		30					62.00	50		50												30		30					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	020	0	1	04	01	H1716_020_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.20	6.00		18.00												0.03	1.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	7	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.17	95.00		190.00					3.17	95.00		285.00					3.17	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									1.10	33.00		66.00					1.10	33.00		99.00					1.10	33.00		99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	7	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									0.00	0.00		0.00					.26	8.00		24.00					.26	8.00		24.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	7	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	7	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	31		31					1.00	31		31					31		31																	31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	001	0	1	04	01	H1846_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					426.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	001	0	1	04	01	H1846_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	001	0	1	04	01	H1846_001_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	001	0	1	04	01	H1846_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.39	12.00	24.00	36.00																					0.40	12.00	24.00	24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	001	0	1	04	01	H1846_001_0	4	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	001	0	1	04	01	H1846_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00	24.00	24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1846	001	0	1	04	01	H1846_001_0	4	1	Preferred Generic	3	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1846	003	0	1	04	01	H1846_003_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	003	0	1	04	01	H1846_003_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	003	0	1	04	01	H1846_003_0	4	2	Non-Preferred Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00	24.00	24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	003	0	1	04	01	H1846_003_0	4	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	003	0	1	04	01	H1846_003_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					792.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1849	015	0	1	01	01	H1849_015_0	5	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1849	015	0	1	01	01	H1849_015_0	5	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1849	015	0	1	01	01	H1849_015_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.41	14.00	28.00	42.00					.56	19.00	38.00	57.00					.41	14.00	28.00	28.00																		19.00				.56	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1849	015	0	1	01	01	H1849_015_0	5	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.12	4.00	8.00	12.00					.26	9.00	18.00	27.00					.12	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1849	015	0	1	01	01	H1849_015_0	5	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1849	015	0	1	01	01	H1849_015_0	5	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													53.00	33	33	33					53.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1894	001	0	1	01	01	H1894_001_0	7	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31						33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1894	001	0	1	01	01	H1894_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	142.50	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1894	001	0	1	01	01	H1894_001_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	67.50	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1894	001	0	1	01	01	H1894_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.19	6.00	12.00	18.00																					.19	6.00	9.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1894	001	0	1	01	01	H1894_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.13	4.00	8.00	12.00																					.13	4.00	6.00	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1894	001	0	1	01	01	H1894_001_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.13	4.00	8.00	12.00																					.13	4.00	6.00	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1903	011	0	1	01	01	H1903_011_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	011	0	1	01	01	H1903_011_0	4	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.32	10.00	20.00	30.00												0.00	0.00	0.00	0.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	011	0	1	01	01	H1903_011_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.09	3.00	6.00	9.00					.64	20.00	40.00	60.00												.09	3.00	6.00	6.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	011	0	1	01	01	H1903_011_0	4	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.61	19.00	38.00	57.00					1.45	45.00	90.00	135.00												.61	19.00	38.00	38.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	011	0	1	01	01	H1903_011_0	4	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.61	50.00	100.00	150.00					2.90	90.00	180.00	270.00												1.61	50.00	100.00	100.00				2.90	90.00	180.00	270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.09	3.00	6.00	9.00					.19	6.00	12.00	18.00												.09	3.00	6.00	0.00				.19	6.00	12.00	18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.70	22.00	44.00	66.00												.48	15.00	30.00	30.00				.70	22.00	44.00	66.00				22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.54	79.00	158.00	237.00					3.03	94.00	188.00	282.00												2.54	79.00	158.00	158.00				3.03	94.00	188.00	282.00				94.00				3.03	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1906	001	0	1	09	04	H1906_001_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1906	001	0	1	09	04	H1906_001_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1906	001	0	1	09	04	H1906_001_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1906	001	0	1	09	04	H1906_001_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1906	001	0	1	09	04	H1906_001_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1906	001	0	1	09	04	H1906_001_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1906	001	0	1	09	04	H1906_001_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1906	001	0	1	09	04	H1906_001_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1906	001	0	1	09	04	H1906_001_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1906	001	0	1	09	04	H1906_001_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.30	9.00		27.00																															18.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					469.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.30	9.00		27.00																															18.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					469.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	001	0	1	01	01	H1951_001_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	001	0	1	01	01	H1951_001_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	001	0	1	01	01	H1951_001_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	001	0	1	01	01	H1951_001_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	001	0	1	01	01	H1951_001_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	001	0	1	01	01	H1951_001_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	001	0	1	01	01	H1951_001_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1951	001	0	1	01	01	H1951_001_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	001	0	1	01	01	H1951_001_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	001	0	1	01	01	H1951_001_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	005	0	1	01	01	H1951_005_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	005	0	1	01	01	H1951_005_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	005	0	1	01	01	H1951_005_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	005	0	1	01	01	H1951_005_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	005	0	1	01	01	H1951_005_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	005	0	1	01	01	H1951_005_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	005	0	1	01	01	H1951_005_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	005	0	1	01	01	H1951_005_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	005	0	1	01	01	H1951_005_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	005	0	1	01	01	H1951_005_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1951	013	0	1	01	01	H1951_013_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	013	0	1	01	01	H1951_013_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1951	013	0	1	01	01	H1951_013_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	013	0	1	01	01	H1951_013_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	013	0	1	01	01	H1951_013_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	013	0	1	01	01	H1951_013_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	024	0	1	01	01	H1951_024_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	024	0	1	01	01	H1951_024_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1951	024	0	1	01	01	H1951_024_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	024	0	1	01	01	H1951_024_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	024	0	1	01	01	H1951_024_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	025	0	1	01	01	H1951_025_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	025	0	1	01	01	H1951_025_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	025	0	1	01	01	H1951_025_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	025	0	1	01	01	H1951_025_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1951	025	0	1	01	01	H1951_025_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	028	0	1	01	01	H1951_028_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1951	028	0	1	01	01	H1951_028_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	028	0	1	01	01	H1951_028_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	028	0	1	01	01	H1951_028_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	028	0	1	01	01	H1951_028_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.46	44.00		132.00																												1.46	44.00		122.00				1.46	44.00		132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.36	41.00		123.00																												1.36	41.00		113.00				1.36	41.00		123.00				41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	035	0	1	01	01	H1951_035_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	035	0	1	01	01	H1951_035_0	3	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	035	0	1	01	01	H1951_035_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.36	41.00		123.00																												1.36	41.00		113.00				1.36	41.00		123.00				41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	035	0	1	01	01	H1951_035_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	035	0	1	01	01	H1951_035_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	036	0	1	01	01	H1951_036_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	036	0	1	01	01	H1951_036_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	036	0	1	01	01	H1951_036_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	036	0	1	01	01	H1951_036_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	036	0	1	01	01	H1951_036_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	036	0	1	01	01	H1951_036_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1951	036	0	1	01	01	H1951_036_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	036	0	1	01	01	H1951_036_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	036	0	1	01	01	H1951_036_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	036	0	1	01	01	H1951_036_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	037	0	1	01	01	H1951_037_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	037	0	1	01	01	H1951_037_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	037	0	1	01	01	H1951_037_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	037	0	1	01	01	H1951_037_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	037	0	1	01	01	H1951_037_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	037	0	1	01	01	H1951_037_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	037	0	1	01	01	H1951_037_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1951	037	0	1	01	01	H1951_037_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	037	0	1	01	01	H1951_037_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	037	0	1	01	01	H1951_037_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	038	0	1	01	01	H1951_038_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1951	038	0	1	01	01	H1951_038_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1951	038	0	1	01	01	H1951_038_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	038	0	1	01	01	H1951_038_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	038	0	1	01	01	H1951_038_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	039	0	1	01	01	H1951_039_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	039	0	1	01	01	H1951_039_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	039	0	1	01	01	H1951_039_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	039	0	1	01	01	H1951_039_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1951	039	0	1	01	01	H1951_039_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1951	039	0	1	01	01	H1951_039_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	042	0	1	01	01	H1951_042_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	042	0	1	01	01	H1951_042_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	042	0	1	01	01	H1951_042_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1951	042	0	1	01	01	H1951_042_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	042	0	1	01	01	H1951_042_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	043	0	1	01	01	H1951_043_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H1951	043	0	1	01	01	H1951_043_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	043	0	1	01	01	H1951_043_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	043	0	1	01	01	H1951_043_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	043	0	1	01	01	H1951_043_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	043	0	1	01	01	H1951_043_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	043	0	1	01	01	H1951_043_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	043	0	1	01	01	H1951_043_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	043	0	1	01	01	H1951_043_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	043	0	1	01	01	H1951_043_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	001	0	1	01	01	H1961_001_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.10	3.00		9.00																								9.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	001	0	1	01	01	H1961_001_0	7	2	Non-Preferred Generic	1	4	000110	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	001	0	1	01	01	H1961_001_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.17	35.00		105.00																								105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	001	0	1	01	01	H1961_001_0	7	2	Non-Preferred Generic	3	4	000110	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								30.00																		10.00				.33	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	001	0	1	01	01	H1961_001_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.10	3.00		9.00																								9.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	001	0	1	01	01	H1961_001_0	7	5	Specialty Tier	1	4	000010	1	1	110		01	100		1	30		90				2			90				30		31					498.94	20		20																							20																	20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	001	0	1	01	01	H1961_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	002	0	1	01	01	H1961_002_0	7	5	Specialty Tier	1	4	000010	1	1	110		01	100		1	30		90				2			90				30		31					1204.94	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	002	0	1	01	01	H1961_002_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.10	3.00		9.00																								9.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	002	0	1	01	01	H1961_002_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.67	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	002	0	1	01	01	H1961_002_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								30.00																		10.00				.33	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	002	0	1	01	01	H1961_002_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.17	35.00		105.00																								105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	002	0	1	01	01	H1961_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	002	0	1	01	01	H1961_002_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.10	3.00		9.00																								9.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.10	3.00		9.00																								9.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	007	0	1	01	01	H1961_007_0	4	5	Specialty Tier	1	4	000010	1	1	110		01	100		1	30		90				2			90				30		31					515.27	20		20																							20																	20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	1.83	55.00		165.00																								165.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.17	35.00		105.00																								105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								30.00																		10.00				.33	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	007	0	1	01	01	H1961_007_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.10	3.00		9.00																								9.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	02	01	H1994_001_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	02	01	H1994_001_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	02	01	H1994_001_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.30	9.00	18.00	27.00																					.30	9.00	18.00	27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	02	01	H1994_001_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	02	01	H1994_001_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					662.16	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	02	01	H1994_002_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	02	01	H1994_002_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.23	7.00	14.00	21.00																					.23	7.00	14.00	21.00																		7.00				.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	02	01	H1994_002_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	02	01	H1994_002_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	02	01	H1994_002_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					662.16	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	02	01	H1994_003_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	02	01	H1994_003_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					662.16	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	02	01	H1994_003_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	02	01	H1994_003_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.23	7.00	14.00	21.00																					.23	7.00	14.00	21.00																		7.00				.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	02	01	H1994_003_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	02	01	H1994_004_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	02	01	H1994_004_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.23	7.00	14.00	21.00																					.23	7.00	14.00	21.00																		7.00				.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	02	01	H1994_004_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	02	01	H1994_004_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	02	01	H1994_004_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					662.16	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	8	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	8	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	8	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.26	8.00		24.00																					0.26	8.00		16.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	8	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.10	3.00		9.00																					0.10	3.00		6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	8	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					761.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					538.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2005	001	0	1	48	05	H2005_001_0	3	1	Generic Drugs	1	4	010000			111		01	111		1	30	60	90				2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2005	001	0	1	48	05	H2005_001_0	3	2	Brand Drugs	1	4	000010			111		01	111		1	30	60	90				2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2005	001	0	1	48	05	H2005_001_0	3	3	Non-Medicare Rx/OTC Drugs	1	4	010010			111		01	111		1	30	60	90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2012	001	0	1	01	01	H2012_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	001	0	1	01	01	H2012_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	001	0	1	01	01	H2012_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	001	0	1	01	01	H2012_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	001	0	1	01	01	H2012_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	001	0	1	01	01	H2012_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	001	0	1	01	01	H2012_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	001	0	1	01	01	H2012_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	001	0	1	01	01	H2012_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	001	0	1	01	01	H2012_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	002	0	1	01	01	H2012_002_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	002	0	1	01	01	H2012_002_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	002	0	1	01	01	H2012_002_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	002	0	1	01	01	H2012_002_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	002	0	1	01	01	H2012_002_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	002	0	1	01	01	H2012_002_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	002	0	1	01	01	H2012_002_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	002	0	1	01	01	H2012_002_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	002	0	1	01	01	H2012_002_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	002	0	1	01	01	H2012_002_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	003	0	1	01	01	H2012_003_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	003	0	1	01	01	H2012_003_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	003	0	1	01	01	H2012_003_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	003	0	1	01	01	H2012_003_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	003	0	1	01	01	H2012_003_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	003	0	1	01	01	H2012_003_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	02	01	H2012_006_0	9	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	02	01	H2012_006_0	9	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	006	0	1	02	01	H2012_006_0	9	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	006	0	1	02	01	H2012_006_0	9	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	006	0	1	02	01	H2012_006_0	9	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	006	0	1	02	01	H2012_006_0	9	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	02	01	H2012_006_0	9	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	02	01	H2012_006_0	9	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	02	01	H2012_006_0	9	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	02	01	H2012_006_0	9	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	007	0	1	01	01	H2012_007_0	11	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	007	0	1	01	01	H2012_007_0	11	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	007	0	1	01	01	H2012_007_0	11	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	007	0	1	01	01	H2012_007_0	11	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	007	0	1	01	01	H2012_007_0	11	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	007	0	1	01	01	H2012_007_0	11	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	007	0	1	01	01	H2012_007_0	11	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	007	0	1	01	01	H2012_007_0	11	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	007	0	1	01	01	H2012_007_0	11	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	007	0	1	01	01	H2012_007_0	11	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	008	0	1	01	01	H2012_008_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	008	0	1	01	01	H2012_008_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	008	0	1	01	01	H2012_008_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	008	0	1	01	01	H2012_008_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	008	0	1	01	01	H2012_008_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	008	0	1	01	01	H2012_008_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	008	0	1	01	01	H2012_008_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	008	0	1	01	01	H2012_008_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	008	0	1	01	01	H2012_008_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	008	0	1	01	01	H2012_008_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	009	0	1	01	01	H2012_009_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	009	0	1	01	01	H2012_009_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	009	0	1	01	01	H2012_009_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	009	0	1	01	01	H2012_009_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	011	0	1	01	01	H2012_011_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	011	0	1	01	01	H2012_011_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	011	0	1	01	01	H2012_011_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	011	0	1	01	01	H2012_011_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	011	0	1	01	01	H2012_011_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	012	0	1	02	01	H2012_012_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	012	0	1	02	01	H2012_012_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	012	0	1	02	01	H2012_012_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	012	0	1	02	01	H2012_012_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	012	0	1	02	01	H2012_012_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	012	0	1	02	01	H2012_012_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	012	0	1	02	01	H2012_012_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	012	0	1	02	01	H2012_012_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	012	0	1	02	01	H2012_012_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	012	0	1	02	01	H2012_012_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	013	0	1	01	01	H2012_013_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	013	0	1	01	01	H2012_013_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	013	0	1	01	01	H2012_013_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	013	0	1	01	01	H2012_013_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	013	0	1	01	01	H2012_013_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	013	0	1	01	01	H2012_013_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	013	0	1	01	01	H2012_013_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	013	0	1	01	01	H2012_013_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	013	0	1	01	01	H2012_013_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	013	0	1	01	01	H2012_013_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	015	0	1	01	01	H2012_015_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	015	0	1	01	01	H2012_015_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	015	0	1	01	01	H2012_015_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	015	0	1	01	01	H2012_015_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	015	0	1	01	01	H2012_015_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	015	0	1	01	01	H2012_015_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	016	0	1	01	01	H2012_016_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	016	0	1	01	01	H2012_016_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	016	0	1	01	01	H2012_016_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	016	0	1	01	01	H2012_016_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	016	0	1	01	01	H2012_016_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	021	0	1	01	01	H2012_021_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	021	0	1	01	01	H2012_021_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	021	0	1	01	01	H2012_021_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	021	0	1	01	01	H2012_021_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	021	0	1	01	01	H2012_021_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	022	0	1	01	01	H2012_022_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	022	0	1	01	01	H2012_022_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	022	0	1	01	01	H2012_022_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	022	0	1	01	01	H2012_022_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	022	0	1	01	01	H2012_022_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	022	0	1	01	01	H2012_022_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	022	0	1	01	01	H2012_022_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	022	0	1	01	01	H2012_022_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	022	0	1	01	01	H2012_022_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	022	0	1	01	01	H2012_022_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	027	0	1	01	01	H2012_027_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	027	0	1	01	01	H2012_027_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	027	0	1	01	01	H2012_027_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	027	0	1	01	01	H2012_027_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	027	0	1	01	01	H2012_027_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	027	0	1	01	01	H2012_027_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	027	0	1	01	01	H2012_027_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	027	0	1	01	01	H2012_027_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	027	0	1	01	01	H2012_027_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	027	0	1	01	01	H2012_027_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	028	0	1	01	01	H2012_028_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	028	0	1	01	01	H2012_028_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	028	0	1	01	01	H2012_028_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	028	0	1	01	01	H2012_028_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	028	0	1	01	01	H2012_028_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	028	0	1	01	01	H2012_028_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	028	0	1	01	01	H2012_028_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	028	0	1	01	01	H2012_028_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	028	0	1	01	01	H2012_028_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	028	0	1	01	01	H2012_028_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	029	0	1	01	01	H2012_029_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	029	0	1	01	01	H2012_029_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	029	0	1	01	01	H2012_029_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	029	0	1	01	01	H2012_029_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	030	0	1	02	01	H2012_030_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	030	0	1	02	01	H2012_030_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.46	44.00		132.00																												1.46	44.00		122.00				1.46	44.00		132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	030	0	1	02	01	H2012_030_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.93	88.00		264.00																												2.93	88.00		254.00				2.93	88.00		264.00				88.00				2.83	88.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	030	0	1	02	01	H2012_030_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	030	0	1	02	01	H2012_030_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	030	0	1	02	01	H2012_030_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	030	0	1	02	01	H2012_030_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.46	44.00		132.00																												1.46	44.00		122.00				1.46	44.00		132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	030	0	1	02	01	H2012_030_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.93	88.00		264.00																												2.93	88.00		254.00				2.93	88.00		264.00				88.00				2.83	88.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	030	0	1	02	01	H2012_030_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	030	0	1	02	01	H2012_030_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	031	0	1	01	01	H2012_031_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	031	0	1	01	01	H2012_031_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	031	0	1	01	01	H2012_031_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	031	0	1	01	01	H2012_031_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	031	0	1	01	01	H2012_031_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	031	0	1	01	01	H2012_031_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	031	0	1	01	01	H2012_031_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	031	0	1	01	01	H2012_031_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	031	0	1	01	01	H2012_031_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	031	0	1	01	01	H2012_031_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	033	0	1	01	01	H2012_033_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	033	0	1	01	01	H2012_033_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	033	0	1	01	01	H2012_033_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	033	0	1	01	01	H2012_033_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	033	0	1	01	01	H2012_033_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	033	0	1	01	01	H2012_033_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	033	0	1	01	01	H2012_033_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	033	0	1	01	01	H2012_033_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	033	0	1	01	01	H2012_033_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	033	0	1	01	01	H2012_033_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	035	0	1	01	01	H2012_035_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	035	0	1	01	01	H2012_035_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	035	0	1	01	01	H2012_035_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	035	0	1	01	01	H2012_035_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	035	0	1	01	01	H2012_035_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	035	0	1	01	01	H2012_035_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	035	0	1	01	01	H2012_035_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	035	0	1	01	01	H2012_035_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	035	0	1	01	01	H2012_035_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	035	0	1	01	01	H2012_035_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	037	0	1	01	01	H2012_037_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	037	0	1	01	01	H2012_037_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	037	0	1	01	01	H2012_037_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	037	0	1	01	01	H2012_037_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	037	0	1	01	01	H2012_037_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	037	0	1	01	01	H2012_037_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	037	0	1	01	01	H2012_037_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	037	0	1	01	01	H2012_037_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	037	0	1	01	01	H2012_037_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	037	0	1	01	01	H2012_037_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	039	0	1	01	01	H2012_039_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	039	0	1	01	01	H2012_039_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	039	0	1	01	01	H2012_039_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	039	0	1	01	01	H2012_039_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	039	0	1	01	01	H2012_039_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	039	0	1	01	01	H2012_039_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	039	0	1	01	01	H2012_039_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	039	0	1	01	01	H2012_039_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	039	0	1	01	01	H2012_039_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	039	0	1	01	01	H2012_039_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	042	0	1	01	01	H2012_042_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	042	0	1	01	01	H2012_042_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	042	0	1	01	01	H2012_042_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	042	0	1	01	01	H2012_042_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	042	0	1	01	01	H2012_042_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	051	0	1	01	01	H2012_051_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	051	0	1	01	01	H2012_051_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	051	0	1	01	01	H2012_051_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	051	0	1	01	01	H2012_051_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	051	0	1	01	01	H2012_051_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	051	0	1	01	01	H2012_051_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	051	0	1	01	01	H2012_051_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	051	0	1	01	01	H2012_051_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	051	0	1	01	01	H2012_051_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	051	0	1	01	01	H2012_051_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	053	0	1	01	01	H2012_053_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	055	0	1	01	01	H2012_055_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	055	0	1	01	01	H2012_055_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	055	0	1	01	01	H2012_055_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	055	0	1	01	01	H2012_055_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	055	0	1	01	01	H2012_055_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	056	0	1	01	01	H2012_056_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	056	0	1	01	01	H2012_056_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	056	0	1	01	01	H2012_056_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	056	0	1	01	01	H2012_056_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	056	0	1	01	01	H2012_056_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	056	0	1	01	01	H2012_056_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	056	0	1	01	01	H2012_056_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	056	0	1	01	01	H2012_056_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	056	0	1	01	01	H2012_056_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	056	0	1	01	01	H2012_056_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	059	0	1	01	01	H2012_059_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	059	0	1	01	01	H2012_059_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	059	0	1	01	01	H2012_059_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	059	0	1	01	01	H2012_059_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	059	0	1	01	01	H2012_059_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	059	0	1	01	01	H2012_059_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	059	0	1	01	01	H2012_059_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	059	0	1	01	01	H2012_059_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	059	0	1	01	01	H2012_059_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	059	0	1	01	01	H2012_059_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	060	0	1	01	01	H2012_060_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	060	0	1	01	01	H2012_060_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	060	0	1	01	01	H2012_060_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	060	0	1	01	01	H2012_060_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	060	0	1	01	01	H2012_060_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	060	0	1	01	01	H2012_060_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	060	0	1	01	01	H2012_060_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	060	0	1	01	01	H2012_060_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	060	0	1	01	01	H2012_060_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	060	0	1	01	01	H2012_060_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	061	0	1	01	01	H2012_061_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	061	0	1	01	01	H2012_061_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	061	0	1	01	01	H2012_061_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	061	0	1	01	01	H2012_061_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	061	0	1	01	01	H2012_061_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	061	0	1	01	01	H2012_061_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	061	0	1	01	01	H2012_061_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	061	0	1	01	01	H2012_061_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	061	0	1	01	01	H2012_061_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	061	0	1	01	01	H2012_061_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	062	0	1	01	01	H2012_062_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	062	0	1	01	01	H2012_062_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	062	0	1	01	01	H2012_062_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	062	0	1	01	01	H2012_062_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	062	0	1	01	01	H2012_062_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	063	0	1	01	01	H2012_063_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	063	0	1	01	01	H2012_063_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	063	0	1	01	01	H2012_063_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	063	0	1	01	01	H2012_063_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	063	0	1	01	01	H2012_063_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	064	0	1	01	01	H2012_064_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	064	0	1	01	01	H2012_064_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	064	0	1	01	01	H2012_064_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	064	0	1	01	01	H2012_064_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	064	0	1	01	01	H2012_064_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	070	0	1	01	01	H2012_070_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	070	0	1	01	01	H2012_070_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	070	0	1	01	01	H2012_070_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	070	0	1	01	01	H2012_070_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	070	0	1	01	01	H2012_070_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	080	0	1	01	01	H2012_080_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	080	0	1	01	01	H2012_080_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	080	0	1	01	01	H2012_080_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.30	9.00		27.00																												0.30	9.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	080	0	1	01	01	H2012_080_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	080	0	1	01	01	H2012_080_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	080	0	1	01	01	H2012_080_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	080	0	1	01	01	H2012_080_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	080	0	1	01	01	H2012_080_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	080	0	1	01	01	H2012_080_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.30	9.00		27.00																												0.30	9.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	080	0	1	01	01	H2012_080_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	082	0	1	01	01	H2012_082_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	082	0	1	01	01	H2012_082_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	082	0	1	01	01	H2012_082_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	082	0	1	01	01	H2012_082_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	082	0	1	01	01	H2012_082_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	082	0	1	01	01	H2012_082_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	082	0	1	01	01	H2012_082_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	082	0	1	01	01	H2012_082_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	082	0	1	01	01	H2012_082_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	082	0	1	01	01	H2012_082_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	084	0	1	01	01	H2012_084_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	084	0	1	01	01	H2012_084_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	084	0	1	01	01	H2012_084_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	084	0	1	01	01	H2012_084_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	084	0	1	01	01	H2012_084_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	084	0	1	01	01	H2012_084_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	084	0	1	01	01	H2012_084_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	084	0	1	01	01	H2012_084_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	084	0	1	01	01	H2012_084_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	084	0	1	01	01	H2012_084_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	085	0	1	01	01	H2012_085_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	085	0	1	01	01	H2012_085_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	085	0	1	01	01	H2012_085_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	085	0	1	01	01	H2012_085_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	085	0	1	01	01	H2012_085_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	085	0	1	01	01	H2012_085_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	085	0	1	01	01	H2012_085_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	085	0	1	01	01	H2012_085_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	085	0	1	01	01	H2012_085_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	085	0	1	01	01	H2012_085_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	087	0	1	01	01	H2012_087_0	6	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	087	0	1	01	01	H2012_087_0	6	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	087	0	1	01	01	H2012_087_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	087	0	1	01	01	H2012_087_0	6	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	087	0	1	01	01	H2012_087_0	6	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	088	0	1	01	01	H2012_088_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	088	0	1	01	01	H2012_088_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	088	0	1	01	01	H2012_088_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	088	0	1	01	01	H2012_088_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	088	0	1	01	01	H2012_088_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	088	0	1	01	01	H2012_088_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	088	0	1	01	01	H2012_088_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	088	0	1	01	01	H2012_088_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	088	0	1	01	01	H2012_088_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	088	0	1	01	01	H2012_088_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	089	0	1	01	01	H2012_089_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	089	0	1	01	01	H2012_089_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	089	0	1	01	01	H2012_089_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	089	0	1	01	01	H2012_089_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	089	0	1	01	01	H2012_089_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	089	0	1	01	01	H2012_089_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	089	0	1	01	01	H2012_089_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	089	0	1	01	01	H2012_089_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	089	0	1	01	01	H2012_089_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	089	0	1	01	01	H2012_089_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	090	0	1	01	01	H2012_090_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	090	0	1	01	01	H2012_090_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	090	0	1	01	01	H2012_090_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	090	0	1	01	01	H2012_090_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	090	0	1	01	01	H2012_090_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	090	0	1	01	01	H2012_090_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	090	0	1	01	01	H2012_090_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	090	0	1	01	01	H2012_090_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	090	0	1	01	01	H2012_090_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	090	0	1	01	01	H2012_090_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	091	0	1	01	01	H2012_091_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	091	0	1	01	01	H2012_091_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	091	0	1	01	01	H2012_091_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	091	0	1	01	01	H2012_091_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	091	0	1	01	01	H2012_091_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	091	0	1	01	01	H2012_091_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	091	0	1	01	01	H2012_091_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	091	0	1	01	01	H2012_091_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	091	0	1	01	01	H2012_091_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	091	0	1	01	01	H2012_091_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	092	0	1	01	01	H2012_092_0	6	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	092	0	1	01	01	H2012_092_0	6	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	092	0	1	01	01	H2012_092_0	6	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	092	0	1	01	01	H2012_092_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	092	0	1	01	01	H2012_092_0	6	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	093	0	1	01	01	H2012_093_0	4	1	Preferred Generic	1	3	001010	3	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	093	0	1	01	01	H2012_093_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	093	0	1	01	01	H2012_093_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	093	0	1	01	01	H2012_093_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	093	0	1	01	01	H2012_093_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	094	0	1	01	01	H2012_094_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	094	0	1	01	01	H2012_094_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	094	0	1	01	01	H2012_094_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	094	0	1	01	01	H2012_094_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	094	0	1	01	01	H2012_094_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	096	0	1	01	01	H2012_096_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	096	0	1	01	01	H2012_096_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	096	0	1	01	01	H2012_096_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	096	0	1	01	01	H2012_096_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	096	0	1	01	01	H2012_096_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	097	0	1	01	01	H2012_097_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	097	0	1	01	01	H2012_097_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	097	0	1	01	01	H2012_097_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	097	0	1	01	01	H2012_097_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2012	097	0	1	01	01	H2012_097_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	098	0	1	01	01	H2012_098_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	098	0	1	01	01	H2012_098_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	098	0	1	01	01	H2012_098_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	098	0	1	01	01	H2012_098_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	098	0	1	01	01	H2012_098_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	098	0	1	01	01	H2012_098_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	098	0	1	01	01	H2012_098_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	098	0	1	01	01	H2012_098_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	098	0	1	01	01	H2012_098_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	098	0	1	01	01	H2012_098_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2029	001	0	1	04	01	H2029_001_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2029	001	0	1	04	01	H2029_001_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2029	001	0	1	04	01	H2029_001_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2029	001	0	1	04	01	H2029_001_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2029	001	0	1	04	01	H2029_001_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2029	001	0	1	04	01	H2029_001_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	002	0	1	04	01	H2029_002_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	002	0	1	04	01	H2029_002_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.26	68.00		204.00																												2.26	68.00		194.00				2.26	68.00		204.00				68.00				2.19	68.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2029	002	0	1	04	01	H2029_002_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2029	002	0	1	04	01	H2029_002_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2029	002	0	1	04	01	H2029_002_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2029	002	0	1	04	01	H2029_002_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	002	0	1	04	01	H2029_002_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.26	68.00		204.00																												2.26	68.00		194.00				2.26	68.00		204.00				68.00				2.19	68.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	002	0	1	04	01	H2029_002_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	002	0	1	04	01	H2029_002_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	002	0	1	04	01	H2029_002_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2108	022	0	1	01	01	H2108_022_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.50	15.00	30.00	45.00																					0.50	15.00		36.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.26	8.00	16.00	24.00																					0.26	8.00		15.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					462.63	29	29	29																					29		29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00		6.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.33	40.00	80.00	120.00																					1.33	40.00		110.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	3	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					555.52	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	029	0	1	01	01	H2108_029_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00		6.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	3	6	Select Diabetic Drugs	1	4	010010	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00		5.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	3	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					449.21	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.33	40.00	80.00	120.00																					1.33	40.00		110.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	3	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					354.74	29	29	29																					29		29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	3	6	Select Diabetic Drugs	1	4	010010	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.33	10.00	20.00	30.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.26	8.00	16.00	24.00																					0.26	8.00		15.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.50	15.00	30.00	45.00																					.50	15.00		36.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2112	007	0	1	01	01	H2112_007_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2112	007	0	1	01	01	H2112_007_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2112	007	0	1	01	01	H2112_007_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2112	007	0	1	01	01	H2112_007_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2112	007	0	1	01	01	H2112_007_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2112	007	0	1	01	01	H2112_007_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2150	002	0	1	18	06	H2150_002_0	4	6	Vaccines	3	4	000001	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	002	0	1	18	06	H2150_002_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					1.10	33.00		99.00												.33	10.00		20.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	002	0	1	18	06	H2150_002_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31									.16	5.00		15.00					.33	10.00		30.00												.16	5.00		10.00				.33	10.00		30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	002	0	1	18	06	H2150_002_0	4	6	Vaccines	1	4	000001	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	4	5	Specialty Tier	1	4	100001	1	1		110	01		110	1				30		90	2				30		90	30		31													577.00	25		25					577.00	25		25												25		25					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31									2.50	75.00		225.00					3.16	95.00		285.00												2.50	75.00		150.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	4	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31									1.33	40.00		120.00					1.50	45.00		135.00												1.33	40.00		80.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31									.16	5.00		15.00					.33	10.00		30.00												.16	5.00		10.00				.33	10.00		30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31									.33	10.00		30.00					1.10	33.00		99.00												.33	10.00		20.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	4	3	Preferred Brand	1	3	000001	1	2		110	01		110	1				30		90	2				30		90	30		31									1.33	40.00		120.00					1.50	45.00		135.00												1.33	40.00		80.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	2				30		90	30		31									.93	28.00		84.00					1.10	33.00		99.00												.93	28.00		56.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	2				30		90	30		31									.23	7.00		21.00					.33	10.00		30.00												.23	7.00		14.00				.33	10.00		30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	4	6	Vaccines	1	3	000001	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	4	5	Specialty Tier	1	3	100001	1	1		110	01		110	1				30		90	2				30		90	30		31													615.00	25		25					615.00	25		25												25		25					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.00	90.00		270.00					3.16	95.00		285.00												3.00	90.00		180.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	4	6	Vaccines	1	3	000001	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		110	1				30		90	2				30		90	30		31									.20	6.00		18.00					.33	10.00		30.00												.20	6.00		12.00				.33	10.00		30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		110	1				30		90	2				30		90	30		31									.60	18.00		54.00					1.10	33.00		99.00												.60	18.00		36.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	4	3	Preferred Brand	1	3	000001	1	2		110	01		110	1				30		90	2				30		90	30		31									1.33	40.00		120.00					1.50	45.00		135.00												1.33	40.00		80.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.00	90.00		270.00					3.16	95.00		285.00												3.00	90.00		180.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	4	5	Specialty Tier	1	3	100001	1	1		110	01		110	1				30		90	2				30		90	30		31													565.00	25		25					565.00	25		25												25		25					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2161	002	0	1	01	01	H2161_002_0	9	1	Preferred Generic	1	4	001000	1	2	111		01			1	30	60	90				1							30		31	0.00	5.00	5.00	5.00																																										5.00				0.00	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2161	002	0	1	01	01	H2161_002_0	9	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31						33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2161	002	0	1	01	01	H2161_002_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01			1	30	60	90				1							30		31	0.00	95.00	95.00	95.00																																										95.00				0.00	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2161	002	0	1	01	01	H2161_002_0	9	3	Preferred Brand	1	4	000001	1	2	111		01			1	30	60	90				1							30		31	0.00	42.00	42.00	42.00																																										42.00				0.00	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2161	002	0	1	01	01	H2161_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01			1	30	60	90				1							30		31	0.00	10.00	10.00	10.00																																										10.00				0.00	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	005	0	1	01	01	H2165_005_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	005	0	1	01	01	H2165_005_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	005	0	1	01	01	H2165_005_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	005	0	1	01	01	H2165_005_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					433.27	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	005	0	1	01	01	H2165_005_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2165	005	0	1	01	01	H2165_005_0	4	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2165	005	0	1	01	01	H2165_005_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	011	0	1	02	01	H2165_011_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	011	0	1	02	01	H2165_011_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	011	0	1	02	01	H2165_011_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	011	0	1	02	01	H2165_011_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					439.25	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	011	0	1	02	01	H2165_011_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	011	0	1	02	01	H2165_011_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2165	011	0	1	02	01	H2165_011_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2165	018	0	1	01	01	H2165_018_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.33	70.00	140.00	210.00																					2.33	70.00		200.00																		70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	3	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					578.09	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00		95.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.26	8.00	16.00	24.00																					0.26	8.00		15.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2174	008	0	1	01	01	H2174_008_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.06	2.00	4.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2174	008	0	1	01	01	H2174_008_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.58	18.00	36.00	54.00																					0.58	18.00	36.00	54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2174	008	0	1	01	01	H2174_008_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2174	008	0	1	01	01	H2174_008_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2174	008	0	1	01	01	H2174_008_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					710.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2224	001	0	1	01	01	H2224_001_0	8	1	Preferred Generic	1	4	001000	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					4.91	25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Specialty Tier												
H2224	001	0	1	01	01	H2224_001_0	8	2	Preferred Brand	1	4	000001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					49.95	25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Specialty Tier												
H2224	001	0	1	01	01	H2224_001_0	8	3	Specialty Tier	1	4	001001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					358.49	25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Specialty Tier												
H2224	001	0	1	01	01	H2224_001_0	8	1	Preferred Generic	3	4	001000	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					0.00	0	0	0																					0	0	0																	0				0	Preferred Generic, Preferred Brand, Specialty Tier										2		2
H2224	003	0	1	01	01	H2224_003_0	10	1	Preferred Generic	1	4	001000	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					4.77	25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Specialty Tier												
H2224	003	0	1	01	01	H2224_003_0	10	2	Preferred Brand	1	4	000001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					45.36	25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Specialty Tier												
H2224	003	0	1	01	01	H2224_003_0	10	3	Specialty Tier	1	4	001001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					372.84	25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Specialty Tier												
H2224	003	0	1	01	01	H2224_003_0	10	1	Preferred Generic	3	4	001000	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					0.00	0	0	0																					0	0	0																	0				0	Preferred Generic, Preferred Brand, Specialty Tier										2		2
H2230	002	0	1	04	01	H2230_002_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.13	4.00	8.00	12.00																					.13	4.00	4.00	4.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.26	8.00	16.00	24.00																					.26	8.00	16.00	16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	9	5	Specialty Tier	1	4	101101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					689.44	30	30	30																					30	30	30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.13	4.00	8.00	12.00																					.13	4.00	4.00	4.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.26	8.00	16.00	24.00																					.26	8.00	16.00	16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	8	5	Specialty Tier	1	4	101101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					634.65	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.20	6.00	12.00	18.00																					.20	6.00	6.00	6.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	10	5	Specialty Tier	1	4	101101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					634.47	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	10	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.40	12.00	24.00	36.00																					.40	12.00	24.00	24.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	10	1	Generic	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.26	8.00	16.00	24.00																					0.26	8.00	16.00	24.00																		8.00				0.25	8.00		Generic, Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	10	3	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Generic, Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	10	2	Brand	1	3	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.60	48.00	96.00	144.00																					1.60	48.00	96.00	144.00																		48.00				1.54	48.00		Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	9	2	Brand	1	3	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.53	46.00	92.00	138.00																					1.53	46.00	92.00	138.00																		46.00				1.48	46.00		Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	9	1	Generic	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.21	6.50	13.00	19.50																					0.21	6.50	13.00	19.50																		6.50				0.20	6.50		Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	9	3	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Generic, Brand, Specialty Tier												
H2241	001	0	1	01	01	H2241_001_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.13	4.00		12.00																								8.00																		4.00				0.13	4.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	001	0	1	01	01	H2241_001_0	8	2	Preferred Brand	1	4	010001	3	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								80.00																		40.00				1.29	40.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	001	0	1	01	01	H2241_001_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.13	4.00		12.00																								8.00																		4.00				.13	4.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2241	001	0	1	01	01	H2241_001_0	8	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					120.78	33		33																							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	001	0	1	01	01	H2241_001_0	8	3	Non-Preferred Brand	1	4	100100	3	2	110		01	100		1	31		90				1			90				31		31	2.58	80.00		240.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					584.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.06	2.00	4.00	6.00																					.06	2.00	3.00	5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.00	30.00	60.00	90.00																					1.00	30.00	60.00	90.00																		30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.50	75.00	150.00	225.00																					2.50	75.00	150.00	225.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.06	2.00	4.00	6.00																					.06	2.00	3.00	5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	1	1	01	01	H2256_001_1	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	2	1	01	01	H2256_001_2	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					584.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.50	75.00	150.00	225.00																					2.50	75.00	150.00	225.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.00	30.00	60.00	90.00																					1.00	30.00	60.00	90.00																		30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.06	2.00	4.00	6.00																					.06	2.00	3.00	5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.06	2.00	4.00	6.00																					.06	2.00	3.00	5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	2	1	01	01	H2256_001_2	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	6	1	01	01	H2256_001_6	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.06	2.00	4.00	6.00																					.06	2.00	3.00	5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.00	30.00	60.00	90.00																					1.00	30.00	60.00	90.00																		30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.50	75.00	150.00	225.00																					2.50	75.00	150.00	225.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					584.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.06	2.00	4.00	6.00																					.06	2.00	3.00	5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	6	1	01	01	H2256_001_6	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	015	1	1	01	01	H2256_015_1	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.26	8.00	16.00	24.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00	70.00	105.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.10	93.00	186.00	279.00																					3.10	93.00	186.00	279.00																		93.00				3.00	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.10	93.00	186.00	279.00																					3.10	93.00	186.00	279.00																		93.00				3.00	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00	70.00	105.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.26	8.00	16.00	24.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.10	93.00	186.00	279.00																					3.10	93.00	186.00	279.00																		93.00				3.00	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00	70.00	105.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.26	8.00	16.00	24.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	1	1	01	01	H2256_018_1	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	1	1	01	01	H2256_018_1	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.26	8.00	16.00	24.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	1	1	01	01	H2256_018_1	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00	70.00	105.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	1	1	01	01	H2256_018_1	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.10	93.00	186.00	279.00																					3.10	93.00	186.00	279.00																		93.00				3.00	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	1	1	01	01	H2256_018_1	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	7	1	01	01	H2256_018_7	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.10	93.00	186.00	279.00																					3.10	93.00	186.00	279.00																		93.00				3.00	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	7	1	01	01	H2256_018_7	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00	70.00	105.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	7	1	01	01	H2256_018_7	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.26	8.00	16.00	24.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	7	1	01	01	H2256_018_7	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	7	1	01	01	H2256_018_7	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	8	1	01	01	H2256_018_8	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.26	8.00	16.00	24.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	8	1	01	01	H2256_018_8	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	8	1	01	01	H2256_018_8	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00	70.00	105.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	8	1	01	01	H2256_018_8	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.10	93.00	186.00	279.00																					3.10	93.00	186.00	279.00																		93.00				3.00	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	8	1	01	01	H2256_018_8	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	1	1	01	01	H2256_026_1	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.26	8.00	16.00	24.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	1	1	01	01	H2256_026_1	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	1	1	01	01	H2256_026_1	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00	70.00	105.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	1	1	01	01	H2256_026_1	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	1	1	01	01	H2256_026_1	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.10	93.00	186.00	279.00																					3.10	93.00	186.00	279.00																		93.00				3.00	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	2	1	01	01	H2256_026_2	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	2	1	01	01	H2256_026_2	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.26	8.00	16.00	24.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	2	1	01	01	H2256_026_2	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.10	93.00	186.00	279.00																					3.10	93.00	186.00	279.00																		93.00				3.00	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	2	1	01	01	H2256_026_2	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00	70.00	105.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	2	1	01	01	H2256_026_2	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	3	1	01	01	H2256_026_3	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.10	93.00	186.00	279.00																					3.10	93.00	186.00	279.00																		93.00				3.00	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	3	1	01	01	H2256_026_3	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	3	1	01	01	H2256_026_3	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	3	1	01	01	H2256_026_3	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.26	8.00	16.00	24.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	3	1	01	01	H2256_026_3	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00	70.00	105.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.26	8.00	16.00	24.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.16	5.00	10.00	15.00																					.13	4.00	8.00	12.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.20	6.00	12.00	18.00																					.16	5.00	10.00	15.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.13	4.00	8.00	12.00																					.10	3.00	7.00	10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.83	25.00	50.00	75.00																					.83	25.00	50.00	75.00																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.83	55.00	110.00	165.00																					1.83	55.00	110.00	165.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.13	4.00	8.00	12.00																					.10	3.00	7.00	10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.20	6.00	12.00	18.00																					.16	5.00	10.00	15.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.83	55.00	110.00	165.00																					1.83	55.00	110.00	165.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.83	25.00	50.00	75.00																					.83	25.00	50.00	75.00																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	036	0	1	01	01	H2256_036_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.13	4.00	8.00	12.00																					.10	3.00	7.00	10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	036	0	1	01	01	H2256_036_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.20	6.00	12.00	18.00																					.16	5.00	10.00	15.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	036	0	1	01	01	H2256_036_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.83	25.00	50.00	75.00																					.83	25.00	50.00	75.00																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	036	0	1	01	01	H2256_036_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.83	55.00	110.00	165.00																					1.83	55.00	110.00	165.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	036	0	1	01	01	H2256_036_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					541.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	9	5	Specialty Tier	1	4	101101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					766.47	30	30	30																					30	30	30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.26	8.00	16.00	24.00																					.26	8.00	16.00	16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.13	4.00	8.00	12.00																					.13	4.00	4.00	4.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	019	0	1	01	01	H2261_019_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	019	0	1	01	01	H2261_019_0	10	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.26	8.00	16.00	24.00																					.26	8.00	16.00	16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	019	0	1	01	01	H2261_019_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.13	4.00	8.00	12.00																					.13	4.00	4.00	4.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	019	0	1	01	01	H2261_019_0	10	5	Specialty Tier	1	4	101101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1074.18	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	019	0	1	01	01	H2261_019_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	004	0	1	01	01	H2312_004_0	7	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	.06	2.00		5.00																								5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	004	0	1	01	01	H2312_004_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.48	15.00		37.50																								37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	004	0	1	01	01	H2312_004_0	7	5	Specialty Tier	1	4	000010	1	1	110		01	100		1	30		90				1			90				30		31					1251.21	27		27																							27																	27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	004	0	1	01	01	H2312_004_0	7	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					63.97	27		27																							27																	27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	004	0	1	01	01	H2312_004_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	007	0	1	02	01	H2312_007_0	9	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					66.09	30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	007	0	1	02	01	H2312_007_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	007	0	1	02	01	H2312_007_0	9	5	Specialty Tier	1	4	000010	1	1	110		01	100		1	30		90				1			90				30		31					1296.47	30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	007	0	1	02	01	H2312_007_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.48	15.00		37.50																								37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	007	0	1	02	01	H2312_007_0	9	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	.06	2.00		5.00																								5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	010	0	1	02	01	H2312_010_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.32	10.00		25.00																								25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2312	010	0	1	02	01	H2312_010_0	10	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	.12	4.00		10.00																								10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2312	010	0	1	02	01	H2312_010_0	10	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	.12	4.00		10.00																								10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	010	0	1	02	01	H2312_010_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.32	10.00		25.00																								25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	010	0	1	02	01	H2312_010_0	10	5	Specialty Tier	1	4	000010	1	1	110		01	100		1	30		90				1			90				30		31					2855.03	31		31																							31																	31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	010	0	1	02	01	H2312_010_0	10	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					66.34	31		31																							31																	31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	010	0	1	02	01	H2312_010_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	012	0	1	02	01	H2312_012_0	7	5	Specialty Tier	1	4	000010	1	1	110		01	100		1	30		90				1			90				30		31					1487.47	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	012	0	1	02	01	H2312_012_0	7	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					72.17	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	012	0	1	02	01	H2312_012_0	7	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	.19	6.00		15.00																								15.00																		6.00				.12	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	012	0	1	02	01	H2312_012_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.32	10.00		25.00																								25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	012	0	1	02	01	H2312_012_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					334.96	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	10	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.74	85.00		255.00																					2.74	85.00		212.50																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	10	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.25	8.00		24.00																					0.25	8.00		20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	10	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		120.00																					1.29	40.00		100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	8	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.74	85.00		255.00																					2.74	85.00		212.50																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					334.96	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	8	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.25	8.00		24.00																					0.25	8.00		20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		120.00																					1.29	40.00		100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	10	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					0.32	10.00		25.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	10	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	10	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	3.06	95.00		285.00																					3.06	95.00		237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					334.96	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	9	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					0.32	10.00		25.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	9	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	3.06	95.00		285.00																					3.06	95.00		237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					334.96	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	9	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	013	0	1	02	01	H2320_013_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					334.96	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	013	0	1	02	01	H2320_013_0	8	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.25	8.00		24.00																					0.25	8.00		20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	013	0	1	02	01	H2320_013_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		120.00																					1.29	40.00		100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	013	0	1	02	01	H2320_013_0	8	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.74	85.00		255.00																					2.74	85.00		212.50																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	8	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	3.06	95.00		285.00																					3.06	95.00		237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					334.96	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	8	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					0.32	10.00		25.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	016	0	1	02	01	H2320_016_0	8	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.74	85.00		255.00																					2.74	85.00		212.50																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	016	0	1	02	01	H2320_016_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		120.00																					1.29	40.00		100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	016	0	1	02	01	H2320_016_0	8	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.25	8.00		24.00																					0.25	8.00		20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	016	0	1	02	01	H2320_016_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					334.96	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	8	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	3.06	95.00		285.00																					3.06	95.00		237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	8	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					0.32	10.00		25.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					334.96	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	019	0	1	02	01	H2320_019_0	8	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.25	8.00		24.00																					0.25	8.00		20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	019	0	1	02	01	H2320_019_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		120.00																					1.29	40.00		100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	019	0	1	02	01	H2320_019_0	8	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.74	85.00		255.00																					2.74	85.00		212.50																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	019	0	1	02	01	H2320_019_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					334.96	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	8	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					0.32	10.00		25.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	8	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	3.06	95.00		285.00																					3.06	95.00		237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					334.96	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	7	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	.12	4.00		10.00																								10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2322	004	0	1	04	01	H2322_004_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.32	10.00		25.00																								25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2322	004	0	1	04	01	H2322_004_0	7	5	Specialty Tier	1	4	000010	1	1	110		01	100		1	30		90				1			90				30		31					1771.60	29		29																							29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	7	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					62.55	29		29																							29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.29	40.00		100.00																								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.32	10.00		25.00																								25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	7	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	.12	4.00		10.00																								10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	8	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					69.64	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	8	5	Specialty Tier	1	4	000010	1	1	110		01	100		1	30		90				1			90				30		31					1560.10	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	8	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	.06	2.00		5.00																								5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.48	15.00		37.50																								37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2323	015	0	1	01	01	H2323_015_0	3	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31						33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2323	015	0	1	01	01	H2323_015_0	3	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.66	80.00		160.00																								160.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2323	015	0	1	01	01	H2323_015_0	3	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		90.00																								90.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2323	015	0	1	01	01	H2323_015_0	3	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.33	10.00		20.00																								20.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2323	016	0	1	01	01	H2323_016_0	4	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.33	40.00		80.00																								80.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2323	016	0	1	01	01	H2323_016_0	4	1	Generic	3	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		10.00																								10.00																		5.00				.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2323	016	0	1	01	01	H2323_016_0	4	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31						33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2323	016	0	1	01	01	H2323_016_0	4	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.66	80.00		160.00																								160.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2323	016	0	1	01	01	H2323_016_0	4	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		10.00																								10.00																		5.00				.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	001	0	1	02	01	H2354_001_0	7	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.33	40.00	80.00	100.00																					1.33	40.00	80.00	100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	001	0	1	02	01	H2354_001_0	7	3	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.17	95.00	190.00	237.50																					3.17	95.00	190.00	237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	001	0	1	02	01	H2354_001_0	7	4	Specialty Tier	1	4	110001	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	33	33	33																					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	001	0	1	02	01	H2354_001_0	7	1	Generic	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.23	7.00	14.00	17.50																					0.23	7.00	14.00	17.50																		7.00				0.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	013	0	1	02	01	H2354_013_0	6	4	Specialty Tier	1	4	110001	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	33	33	33																					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	013	0	1	02	01	H2354_013_0	6	3	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	90.00	180.00	225.00																					3.00	90.00	180.00	225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	013	0	1	02	01	H2354_013_0	6	1	Generic	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.20	6.00	12.00	15.00																					0.20	6.00	12.00	15.00																		6.00				0.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	013	0	1	02	01	H2354_013_0	6	1	Generic	3	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.20	6.00	12.00	15.00																					0.20	6.00	12.00	15.00																		6.00				0.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2354	013	0	1	02	01	H2354_013_0	6	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.27	38.00	76.00	95.00																					1.27	38.00	76.00	95.00																		38.00				1.23	38.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	02	01	H2354_015_0	6	2	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.40	42.00	84.00	105.00																					1.40	42.00	84.00	105.00																		42.00				1.35	42.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	02	01	H2354_015_0	6	3	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.17	95.00	190.00	237.50																					3.17	95.00	190.00	237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	02	01	H2354_015_0	6	4	Specialty Tier	1	3	110001	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	02	01	H2354_015_0	6	1	Generic	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.23	7.00	14.00	17.50																					.23	7.00	14.00	17.50																		7.00				.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2425	002	0	1	02	01	H2425_002_0	6	1	Preferred Generic	1	3	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	.22	7.00	14.00	21.00																								14.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2425	002	0	1	02	01	H2425_002_0	6	2	Non-Preferred Generic	1	3	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.45	14.00	28.00	42.00																								28.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2425	002	0	1	02	01	H2425_002_0	6	3	Preferred Brand	1	3	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.29	40.00	80.00	120.00																								80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2425	002	0	1	02	01	H2425_002_0	6	4	Non-Preferred Brand	1	3	110000	1	1	111		01	100		1	31	60	90				1			90				31		31					37.54	45	45	45																							45																	45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2450	001	0	1	18	06	H2450_001_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		93				1			93				31		31					292.76	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		93				1			93				31		31	2.54	79.00		237.00																								237.00																		79.00				2.54	79.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	6	1	Generic	1	4	010000	1	2	110		01	100		1	31		93				1			93				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		93				1			93				31		31	1.25	39.00		117.00																								117.00																		39.00				1.25	39.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		93				1			93				31		31	2.54	79.00		237.00																								237.00																		79.00				2.54	79.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		93				1			93				31		31	1.25	39.00		117.00																								117.00																		39.00				1.25	39.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	8	1	Generic	1	4	010000	1	2	110		01	100		1	31		93				1			93				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	8	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		93				1			93				31		31					293.40	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	4	1	Generic	1	4	010000	1	2	110		01	100		1	31		93				1			93				31		31	.32	10.00		30.00																								30.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	4	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		93				1			93				31		31	1.25	39.00		117.00																								117.00																		39.00				1.25	39.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	4	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		93				1			93				31		31	2.54	79.00		237.00																								237.00																		79.00				2.54	79.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	4	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		93				1			93				31		31					359.18	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	6	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	.16	5.00		12.50																								10.00																			5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	.50	15.00		37.50																								30.00																			15.00			0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	6	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	1.33	40.00		100.00																								80.00																			40.00			1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	2.66	80.00		200.00																								160.00																			80.00			2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	6	5	Specialty Tier	1	4	010010	1	1	110		10	100		1	30		90				1			90					29	31					897.46	25		25																							25																		25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	6	1	Preferred Generic	3	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	.16	5.00		12.50																								10.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2459	002	0	1	02	01	H2459_002_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	.50	15.00		37.50																								30.00																			15.00			.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2459	013	0	1	02	01	H2459_013_0	9	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	1.33	40.00		100.00																								80.00																			40.00			1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	9	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	.16	5.00		12.50																								10.00																			5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	.50	15.00		37.50																								30.00																			15.00			0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	2.66	80.00		200.00																								160.00																			80.00			2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	9	5	Specialty Tier	1	4	010010	1	1	110		10	100		1	30		90				1			90					29	31					938.26	25		25																							25																		25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	9	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	1.50	45.00		135.00																								90.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	9	5	Specialty Tier	1	4	010010	1	1	110		10	100		1	30		90				1			90					29	31					1238.50	33		33																							33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	3.00	90.00		270.00																								180.00																			90.00			2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	9	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	.16	5.00		15.00																								10.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	.83	25.00		75.00																								50.00																			25.00			.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					870.38	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_0	7	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.17	5.00		15.00																												0.17	5.00		10.00				0.17	5.00		15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		30.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_0	7	3	Preferred Brand	1	4	000001	1	2	110		01		110	1	30		90				1				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		90.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01		110	1	30		90				1				30		90	30		31	3.17	95.00		285.00																												3.17	95.00		190.00				3.17	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	011	0	1	18	06	H2462_011_0	6	2	Non-Preferred Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		30.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	011	0	1	18	06	H2462_011_0	6	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.17	5.00		15.00																												0.17	5.00		10.00				0.17	5.00		15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	011	0	1	18	06	H2462_011_0	6	4	Non-Preferred Brand	1	3	100000	1	2	110		01		110	1	30		90				1				30		90	30		31	3.17	95.00		285.00																												3.17	95.00		190.00				3.17	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	011	0	1	18	06	H2462_011_0	6	3	Preferred Brand	1	3	000001	1	2	110		01		110	1	30		90				1				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		90.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	011	0	1	18	06	H2462_011_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1108.80	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	012	0	1	18	06	H2462_012_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01		110	1	30		90				1				30		90	30		31	2.17	65.00		195.00																												2.17	65.00		130.00				2.17	65.00		195.00				65.00				2.10	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	012	0	1	18	06	H2462_012_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					729.94	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	012	0	1	18	06	H2462_012_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		24.00				0.40	12.00		36.00				12.00				0.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	012	0	1	18	06	H2462_012_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.17	5.00		15.00																												0.17	5.00		10.00				0.17	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	012	0	1	18	06	H2462_012_0	6	3	Preferred Brand	3	4	000001	1	1	110		01		110	1	30		90				1				30		90	30		31					108.60	40		40																												40		40					45		45			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2462	012	0	1	18	06	H2462_012_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		24.00				0.40	12.00		36.00				12.00				0.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2462	012	0	1	18	06	H2462_012_0	6	1	Preferred Generic	3	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.17	5.00		15.00																												0.17	5.00		10.00				0.17	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2462	012	0	1	18	06	H2462_012_0	6	3	Preferred Brand	1	4	000001	1	2	110		01		110	1	30		90				1				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		80.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01		110	1	30		90				1				30		90	30		31	3.17	95.00		285.00																												3.17	95.00		190.00				3.17	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					989.70	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	5	3	Preferred Brand	1	4	000001	1	2	110		01		110	1	30		90				1				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		90.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	0.67	20.00		60.00																												.67	20.00		40.00				.67	20.00		60.00				20.00				.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.17	5.00		15.00																												0.17	5.00		10.00				0.17	5.00		15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2486	003	0	1	01	01	H2486_003_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.46	44.00		132.00																												1.46	44.00		122.00				1.46	44.00		132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2486	003	0	1	01	01	H2486_003_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.46	44.00		132.00																												1.46	44.00		122.00				1.46	44.00		132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2486	003	0	1	01	01	H2486_003_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2486	003	0	1	01	01	H2486_003_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2491	002	0	1	02	01	H2491_002_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	002	0	1	02	01	H2491_002_0	3	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.35	73.00	146.00	219.00					2.83	88.00	176.00	264.00												2.35	73.00	146.00	146.00				2.83	88.00	176.00	264.00				88.00				2.83	88.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	002	0	1	02	01	H2491_002_0	3	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	002	0	1	02	01	H2491_002_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.70	22.00	44.00	66.00												.48	15.00	30.00	30.00				.70	22.00	44.00	66.00				22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	002	0	1	02	01	H2491_002_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.09	3.00	6.00	9.00					.19	6.00	12.00	18.00												.09	3.00	6.00	0.00				.19	6.00	12.00	18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	02	01	H2491_004_0	4	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	02	01	H2491_004_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.64	20.00	40.00	60.00												.06	2.00	4.00	4.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	02	01	H2491_004_0	4	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					1.29	40.00	80.00	120.00												.48	15.00	30.00	30.00				1.29	40.00	80.00	120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	02	01	H2491_004_0	4	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.61	50.00	100.00	150.00					2.87	89.00	178.00	267.00												1.61	50.00	100.00	100.00				2.87	89.00	178.00	267.00				89.00				2.87	89.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	02	01	H2491_004_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2506	001	0	1	48	05	H2506_001_0	6	2	Brand Drugs	1	4	000010			111		10	111		1	30	60	90				1	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2506	001	0	1	48	05	H2506_001_0	6	3	Non-Medicare Rx Generic Drugs	1	4	010000			111		10	111		1	30	60	90				1	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2506	001	0	1	48	05	H2506_001_0	6	4	Non-Medicare Rx Brand Drugs	1	4	000010			111		10	111		1	30	60	90				1	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2506	001	0	1	48	05	H2506_001_0	6	5	Non-Medicare OTC Generic Drugs	1	4	010010			111		10	111		1	30	60	90				1	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2506	001	0	1	48	05	H2506_001_0	6	1	Generic Drugs	1	4	010000			111		10	111		1	30	60	90				1	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2531	001	0	1	48	05	H2531_001_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			111		01	111		1	30	60	90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2531	001	0	1	48	05	H2531_001_0	4	2	Brand Drugs	1	4	000010			111		01	111		1	30	60	90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H2531	001	0	1	48	05	H2531_001_0	4	1	Generic Drugs	1	4	010000			111		01	111		1	30	60	90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H2542	001	0	1	04	01	H2542_001_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	001	0	1	04	01	H2542_001_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	001	0	1	04	01	H2542_001_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	001	0	1	04	01	H2542_001_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	001	0	1	04	01	H2542_001_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2542	001	0	1	04	01	H2542_001_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2542	001	0	1	04	01	H2542_001_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2542	001	0	1	04	01	H2542_001_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2542	001	0	1	04	01	H2542_001_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2542	001	0	1	04	01	H2542_001_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	002	0	1	04	01	H2542_002_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2542	002	0	1	04	01	H2542_002_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2542	002	0	1	04	01	H2542_002_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2542	002	0	1	04	01	H2542_002_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2542	002	0	1	04	01	H2542_002_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2542	002	0	1	04	01	H2542_002_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	002	0	1	04	01	H2542_002_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	002	0	1	04	01	H2542_002_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	002	0	1	04	01	H2542_002_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	002	0	1	04	01	H2542_002_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	003	0	1	04	01	H2542_003_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2542	003	0	1	04	01	H2542_003_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2542	003	0	1	04	01	H2542_003_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2542	003	0	1	04	01	H2542_003_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	003	0	1	04	01	H2542_003_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2542	003	0	1	04	01	H2542_003_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	003	0	1	04	01	H2542_003_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	003	0	1	04	01	H2542_003_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	003	0	1	04	01	H2542_003_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2542	003	0	1	04	01	H2542_003_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	004	0	1	04	01	H2542_004_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2542	004	0	1	04	01	H2542_004_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2542	004	0	1	04	01	H2542_004_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2542	004	0	1	04	01	H2542_004_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2542	004	0	1	04	01	H2542_004_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2542	004	0	1	04	01	H2542_004_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	004	0	1	04	01	H2542_004_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	004	0	1	04	01	H2542_004_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	004	0	1	04	01	H2542_004_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2542	004	0	1	04	01	H2542_004_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		34	0.23	8.00		24.00																								16.00																		8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	1.33	40.00		120.00																								100.00																		40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	2.67	80.00		240.00																								200.00																		80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		34					285.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	002	0	1	01	01	H2563_002_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	002	0	1	01	01	H2563_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		34	.15	5.00		15.00																								10.00																		5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	002	0	1	01	01	H2563_002_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	.88	30.00		90.00																								75.00																		30.00				.88	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	002	0	1	01	01	H2563_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	1.76	60.00		180.00																								150.00																		60.00				1.76	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	002	0	1	01	01	H2563_002_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		34					250.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2593	001	0	1	01	01	H2593_001_0	10	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	10	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	001	0	1	01	01	H2593_001_0	10	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	001	0	1	01	01	H2593_001_0	10	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	001	0	1	01	01	H2593_001_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	8	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	003	0	1	01	01	H2593_003_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	003	0	1	01	01	H2593_003_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	003	0	1	01	01	H2593_003_0	8	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	8	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	003	0	1	01	01	H2593_003_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	8	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	003	0	1	01	01	H2593_003_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	8	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	005	0	1	01	01	H2593_005_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	005	0	1	01	01	H2593_005_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	005	0	1	01	01	H2593_005_0	8	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	8	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	005	0	1	01	01	H2593_005_0	8	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	006	0	1	01	01	H2593_006_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	12	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	006	0	1	01	01	H2593_006_0	12	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	006	0	1	01	01	H2593_006_0	12	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	006	0	1	01	01	H2593_006_0	12	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	006	0	1	01	01	H2593_006_0	12	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	006	0	1	01	01	H2593_006_0	12	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	12	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	12	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	007	0	1	01	01	H2593_007_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	007	0	1	01	01	H2593_007_0	7	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	007	0	1	01	01	H2593_007_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	007	0	1	01	01	H2593_007_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	007	0	1	01	01	H2593_007_0	7	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	007	0	1	01	01	H2593_007_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	007	0	1	01	01	H2593_007_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	007	0	1	01	01	H2593_007_0	7	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	007	0	1	01	01	H2593_007_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	011	0	1	01	01	H2593_011_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	011	0	1	01	01	H2593_011_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	011	0	1	01	01	H2593_011_0	7	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	011	0	1	01	01	H2593_011_0	7	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	011	0	1	01	01	H2593_011_0	7	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	011	0	1	01	01	H2593_011_0	7	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	011	0	1	01	01	H2593_011_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	011	0	1	01	01	H2593_011_0	7	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	011	0	1	01	01	H2593_011_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	011	0	1	01	01	H2593_011_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	011	0	1	01	01	H2593_011_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	013	0	1	01	01	H2593_013_0	5	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	013	0	1	01	01	H2593_013_0	5	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	013	0	1	01	01	H2593_013_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	013	0	1	01	01	H2593_013_0	5	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	013	0	1	01	01	H2593_013_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	014	0	1	01	01	H2593_014_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	014	0	1	01	01	H2593_014_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	014	0	1	01	01	H2593_014_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	014	0	1	01	01	H2593_014_0	5	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	014	0	1	01	01	H2593_014_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	014	0	1	01	01	H2593_014_0	5	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	014	0	1	01	01	H2593_014_0	5	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	014	0	1	01	01	H2593_014_0	5	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	014	0	1	01	01	H2593_014_0	5	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	014	0	1	01	01	H2593_014_0	5	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	014	0	1	01	01	H2593_014_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	015	0	1	01	01	H2593_015_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	015	0	1	01	01	H2593_015_0	5	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	015	0	1	01	01	H2593_015_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	015	0	1	01	01	H2593_015_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	015	0	1	01	01	H2593_015_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	015	0	1	01	01	H2593_015_0	5	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	015	0	1	01	01	H2593_015_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	015	0	1	01	01	H2593_015_0	5	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	015	0	1	01	01	H2593_015_0	5	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	015	0	1	01	01	H2593_015_0	5	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H2593	015	0	1	01	01	H2593_015_0	5	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	016	0	1	01	01	H2593_016_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	016	0	1	01	01	H2593_016_0	7	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.32	10.00		30.00					0.32	10.00		30.00								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	016	0	1	01	01	H2593_016_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	016	0	1	01	01	H2593_016_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.90	90.00		270.00					3.06	95.00		285.00								225.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	016	0	1	01	01	H2593_016_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.29	40.00		120.00					1.45	45.00		135.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	016	0	1	01	01	H2593_016_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.25	8.00		24.00					0.41	13.00		39.00								20.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.25	8.00		24.00					0.41	13.00		39.00								20.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.29	40.00		120.00					1.45	45.00		135.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.90	90.00		270.00					3.06	95.00		285.00								225.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.32	10.00		30.00					0.32	10.00		30.00								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2610	005	0	1	01	01	H2610_005_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									1.09	34.00	68.00	102.00					1.25	39.00	78.00	117.00					1.25	39.00	78.00	117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	005	0	1	01	01	H2610_005_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									0.00	0.00	0.00	0.00					.16	5.00	10.00	15.00					.16	5.00	10.00	15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	005	0	1	01	01	H2610_005_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									0.00	0.00	0.00	0.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	005	0	1	01	01	H2610_005_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									2.09	65.00	130.00	195.00					2.41	75.00	150.00	225.00					2.41	75.00	150.00	225.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	005	0	1	01	01	H2610_005_0	6	5	Specialty Tier	1	4	100100	1	1		010	01	010		1				31				31						31		31													2278.57	33							2278.57	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									.93	29.00	58.00	87.00					1.09	34.00	68.00	102.00					1.09	34.00	68.00	102.00																		34.00				1.09	34.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									0.00	0.00	0.00	0.00					.16	5.00	10.00	15.00					.16	5.00	10.00	15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									0.00	0.00	0.00	0.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									1.77	55.00	110.00	165.00					2.09	65.00	130.00	195.00					2.09	65.00	130.00	195.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	5	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									0.00	0.00	0.00	0.00					.16	5.00	10.00	15.00					.16	5.00	10.00	15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2610	006	0	1	01	01	H2610_006_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									0.00	0.00	0.00	0.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2610	006	0	1	01	01	H2610_006_0	5	5	Specialty Tier	1	4	100100	1	1		010	01	010		1				31				31						31		31													1592.43	33							1592.43	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									0.00	0.00	0.00	0.00					.22	7.00	14.00	21.00					.22	7.00	14.00	21.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									2.41	75.00	150.00	225.00					2.74	85.00	170.00	255.00					2.74	85.00	170.00	255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									1.19	37.00	74.00	111.00					1.35	42.00	84.00	126.00					1.35	42.00	84.00	126.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									0.00	0.00	0.00	0.00					.32	10.00	20.00	30.00					.32	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	5	5	Specialty Tier	1	4	100100	1	1		010	01	010		1				31				31						31		31													1396.08	33							1396.08	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	014	0	1	02	01	H2610_014_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									0.00	0.00	0.00	0.00					.06	2.00	4.00	6.00					.06	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	014	0	1	02	01	H2610_014_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									0.00	0.00	0.00	0.00					.16	5.00	10.00	15.00					.16	5.00	10.00	15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	014	0	1	02	01	H2610_014_0	6	5	Specialty Tier	1	4	100100	1	1		010	01	010		1				31				31						31		31													2278.57	33							2278.57	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	014	0	1	02	01	H2610_014_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									2.09	65.00	130.00	195.00					2.41	75.00	150.00	225.00					2.41	75.00	150.00	225.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	014	0	1	02	01	H2610_014_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				31	62	93	1	31	62	93				31		31									1.09	34.00	68.00	102.00					1.25	39.00	78.00	117.00					1.25	39.00	78.00	117.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	001	0	1	04	01	H2611_001_0	7	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.40	12.00	24.00	36.00					0.13	4.00	8.00	12.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	001	0	1	04	01	H2611_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					0.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	001	0	1	04	01	H2611_001_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.00	30.00	60.00	90.00					1.50	45.00	90.00	135.00					1.00	30.00	60.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	001	0	1	04	01	H2611_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.16	65.00	130.00	195.00					3.16	95.00	190.00	285.00					2.16	65.00	130.00	195.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	001	0	1	04	01	H2611_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	008	0	1	04	01	H2611_008_0	10	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					.50	15.00	30.00	45.00					.33	10.00	20.00	30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	008	0	1	04	01	H2611_008_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.20	6.00	12.00	18.00					.30	9.00	18.00	27.00					.20	6.00	12.00	18.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	008	0	1	04	01	H2611_008_0	10	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	008	0	1	04	01	H2611_008_0	10	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	008	0	1	04	01	H2611_008_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	018	0	1	04	01	H2611_018_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.16	5.00	10.00	15.00					.26	8.00	16.00	24.00					.16	5.00	10.00	12.50																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	018	0	1	04	01	H2611_018_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	018	0	1	04	01	H2611_018_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					.50	15.00	30.00	45.00					.33	10.00	20.00	30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	018	0	1	04	01	H2611_018_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.36	41.00	82.00	123.00					1.50	45.00	90.00	135.00					1.36	41.00	82.00	123.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2611	018	0	1	04	01	H2611_018_0	8	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	004	0	1	01	01	H2649_004_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	004	0	1	01	01	H2649_004_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	004	0	1	01	01	H2649_004_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	004	0	1	01	01	H2649_004_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	004	0	1	01	01	H2649_004_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	004	0	1	01	01	H2649_004_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	004	0	1	01	01	H2649_004_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	004	0	1	01	01	H2649_004_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	004	0	1	01	01	H2649_004_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	004	0	1	01	01	H2649_004_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	020	0	1	01	01	H2649_020_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	020	0	1	01	01	H2649_020_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	020	0	1	01	01	H2649_020_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	020	0	1	01	01	H2649_020_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	020	0	1	01	01	H2649_020_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	020	0	1	01	01	H2649_020_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	020	0	1	01	01	H2649_020_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	020	0	1	01	01	H2649_020_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	020	0	1	01	01	H2649_020_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	020	0	1	01	01	H2649_020_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	021	0	1	02	01	H2649_021_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	021	0	1	02	01	H2649_021_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	021	0	1	02	01	H2649_021_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	021	0	1	02	01	H2649_021_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	021	0	1	02	01	H2649_021_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	021	0	1	02	01	H2649_021_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	021	0	1	02	01	H2649_021_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	021	0	1	02	01	H2649_021_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	021	0	1	02	01	H2649_021_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	021	0	1	02	01	H2649_021_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	022	0	1	01	01	H2649_022_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	022	0	1	01	01	H2649_022_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	022	0	1	01	01	H2649_022_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	022	0	1	01	01	H2649_022_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	022	0	1	01	01	H2649_022_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	022	0	1	01	01	H2649_022_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	022	0	1	01	01	H2649_022_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	022	0	1	01	01	H2649_022_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	022	0	1	01	01	H2649_022_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	022	0	1	01	01	H2649_022_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	023	0	1	01	01	H2649_023_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	023	0	1	01	01	H2649_023_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	023	0	1	01	01	H2649_023_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	023	0	1	01	01	H2649_023_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	023	0	1	01	01	H2649_023_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	023	0	1	01	01	H2649_023_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	023	0	1	01	01	H2649_023_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	023	0	1	01	01	H2649_023_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	023	0	1	01	01	H2649_023_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	023	0	1	01	01	H2649_023_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	024	0	1	01	01	H2649_024_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	28							1.00	28														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	024	0	1	01	01	H2649_024_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													45.00	34		34					69.00	50		50												34		34					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	024	0	1	01	01	H2649_024_0	4	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													16.00	17		17					25.00	25		25												17		17					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	024	0	1	01	01	H2649_024_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.30	9.00		27.00												0.10	3.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	024	0	1	01	01	H2649_024_0	4	5	Specialty Tier	3	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	28							1.00	28														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	024	0	1	01	01	H2649_024_0	4	2	Non-Preferred Generic	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.30	9.00		27.00												0.10	3.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	024	0	1	01	01	H2649_024_0	4	3	Preferred Brand	3	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													23.00	17		17					35.00	25		25												17		17					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	024	0	1	01	01	H2649_024_0	4	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.00	90.00		270.00					3.16	95.00		285.00												3.00	90.00		260.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	024	0	1	01	01	H2649_024_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.23	7.00		21.00												0.03	1.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	025	0	1	01	01	H2649_025_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	025	0	1	01	01	H2649_025_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	025	0	1	01	01	H2649_025_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	025	0	1	01	01	H2649_025_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	025	0	1	01	01	H2649_025_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	025	0	1	01	01	H2649_025_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	025	0	1	01	01	H2649_025_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	025	0	1	01	01	H2649_025_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	025	0	1	01	01	H2649_025_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	025	0	1	01	01	H2649_025_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	029	0	1	01	01	H2649_029_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	029	0	1	01	01	H2649_029_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	029	0	1	01	01	H2649_029_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	029	0	1	01	01	H2649_029_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.33	70.00		210.00																												2.33	70.00		200.00				2.33	70.00		210.00				70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	029	0	1	01	01	H2649_029_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	029	0	1	01	01	H2649_029_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.33	70.00		210.00																												2.33	70.00		200.00				2.33	70.00		210.00				70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	029	0	1	01	01	H2649_029_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	029	0	1	01	01	H2649_029_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	029	0	1	01	01	H2649_029_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	029	0	1	01	01	H2649_029_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	030	0	1	02	01	H2649_030_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	030	0	1	02	01	H2649_030_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	030	0	1	02	01	H2649_030_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	030	0	1	02	01	H2649_030_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	030	0	1	02	01	H2649_030_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	030	0	1	02	01	H2649_030_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	030	0	1	02	01	H2649_030_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	030	0	1	02	01	H2649_030_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	030	0	1	02	01	H2649_030_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	030	0	1	02	01	H2649_030_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	031	0	1	01	01	H2649_031_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	031	0	1	01	01	H2649_031_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	031	0	1	01	01	H2649_031_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	031	0	1	01	01	H2649_031_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	031	0	1	01	01	H2649_031_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	031	0	1	01	01	H2649_031_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	032	0	1	01	01	H2649_032_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	032	0	1	01	01	H2649_032_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	032	0	1	01	01	H2649_032_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	032	0	1	01	01	H2649_032_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	032	0	1	01	01	H2649_032_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	032	0	1	01	01	H2649_032_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	032	0	1	01	01	H2649_032_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	032	0	1	01	01	H2649_032_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	032	0	1	01	01	H2649_032_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	032	0	1	01	01	H2649_032_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	033	0	1	01	01	H2649_033_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	033	0	1	01	01	H2649_033_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	033	0	1	01	01	H2649_033_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	033	0	1	01	01	H2649_033_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	033	0	1	01	01	H2649_033_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	033	0	1	01	01	H2649_033_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	033	0	1	01	01	H2649_033_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	033	0	1	01	01	H2649_033_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	033	0	1	01	01	H2649_033_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	033	0	1	01	01	H2649_033_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	034	0	1	01	01	H2649_034_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	034	0	1	01	01	H2649_034_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	034	0	1	01	01	H2649_034_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	034	0	1	01	01	H2649_034_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	034	0	1	01	01	H2649_034_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	034	0	1	01	01	H2649_034_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	034	0	1	01	01	H2649_034_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	034	0	1	01	01	H2649_034_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	034	0	1	01	01	H2649_034_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	034	0	1	01	01	H2649_034_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	035	0	1	01	01	H2649_035_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	035	0	1	01	01	H2649_035_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	035	0	1	01	01	H2649_035_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	035	0	1	01	01	H2649_035_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	035	0	1	01	01	H2649_035_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	035	0	1	01	01	H2649_035_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	035	0	1	01	01	H2649_035_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	035	0	1	01	01	H2649_035_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	035	0	1	01	01	H2649_035_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	035	0	1	01	01	H2649_035_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	036	0	1	01	01	H2649_036_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	036	0	1	01	01	H2649_036_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	036	0	1	01	01	H2649_036_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	036	0	1	01	01	H2649_036_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	036	0	1	01	01	H2649_036_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	036	0	1	01	01	H2649_036_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	036	0	1	01	01	H2649_036_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	036	0	1	01	01	H2649_036_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	036	0	1	01	01	H2649_036_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	036	0	1	01	01	H2649_036_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	037	0	1	01	01	H2649_037_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	037	0	1	01	01	H2649_037_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	037	0	1	01	01	H2649_037_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	037	0	1	01	01	H2649_037_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	037	0	1	01	01	H2649_037_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	037	0	1	01	01	H2649_037_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	037	0	1	01	01	H2649_037_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	037	0	1	01	01	H2649_037_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	037	0	1	01	01	H2649_037_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	037	0	1	01	01	H2649_037_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	038	0	1	01	01	H2649_038_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	038	0	1	01	01	H2649_038_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	038	0	1	01	01	H2649_038_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	038	0	1	01	01	H2649_038_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	038	0	1	01	01	H2649_038_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	039	0	1	01	01	H2649_039_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	039	0	1	01	01	H2649_039_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	039	0	1	01	01	H2649_039_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.30	9.00		27.00																												0.30	9.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	039	0	1	01	01	H2649_039_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	039	0	1	01	01	H2649_039_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	040	0	1	01	01	H2649_040_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	040	0	1	01	01	H2649_040_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	040	0	1	01	01	H2649_040_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.30	9.00		27.00																												0.30	9.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	040	0	1	01	01	H2649_040_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	040	0	1	01	01	H2649_040_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	041	0	1	01	01	H2649_041_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	041	0	1	01	01	H2649_041_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	041	0	1	01	01	H2649_041_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	041	0	1	01	01	H2649_041_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	041	0	1	01	01	H2649_041_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	041	0	1	01	01	H2649_041_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2649	041	0	1	01	01	H2649_041_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	041	0	1	01	01	H2649_041_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	041	0	1	01	01	H2649_041_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	041	0	1	01	01	H2649_041_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	004	0	1	01	01	H2654_004_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	004	0	1	01	01	H2654_004_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	004	0	1	01	01	H2654_004_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	004	0	1	01	01	H2654_004_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	004	0	1	01	01	H2654_004_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					568.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	010	0	1	01	01	H2654_010_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	010	0	1	01	01	H2654_010_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	010	0	1	01	01	H2654_010_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	010	0	1	01	01	H2654_010_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					677.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	010	0	1	01	01	H2654_010_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	02	01	H2654_013_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	02	01	H2654_013_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	02	01	H2654_013_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	02	01	H2654_013_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	02	01	H2654_013_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					582.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	002	0	1	02	01	H2663_002_0	11	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	002	0	1	02	01	H2663_002_0	11	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.00	30.00	60.00	90.00					1.50	45.00	90.00	135.00					1.00	30.00	60.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	002	0	1	02	01	H2663_002_0	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.26	8.00	16.00	24.00					0.13	4.00	8.00	12.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	002	0	1	02	01	H2663_002_0	11	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.26	8.00	16.00	24.00					0.50	15.00	30.00	45.00					0.26	8.00	16.00	24.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	002	0	1	02	01	H2663_002_0	11	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.16	65.00	130.00	195.00					3.16	95.00	190.00	285.00					2.16	65.00	130.00	195.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					0.20	6.00	12.00	18.00					0.00	0.00	0.00	0.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	8	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.50	15.00	30.00	45.00					0.16	5.00	10.00	15.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.00	30.00	60.00	90.00					1.50	45.00	90.00	135.00					1.00	30.00	60.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	8	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.16	65.00	130.00	195.00					3.16	95.00	190.00	285.00					2.16	65.00	130.00	195.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	006	0	1	01	01	H2663_006_0	8	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	006	0	1	01	01	H2663_006_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.16	65.00	130.00	195.00					3.16	95.00	190.00	285.00					2.16	65.00	130.00	195.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	006	0	1	01	01	H2663_006_0	8	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.40	12.00	24.00	36.00					0.13	4.00	8.00	12.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	006	0	1	01	01	H2663_006_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.00	30.00	60.00	90.00					1.50	45.00	90.00	135.00					1.00	30.00	60.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	006	0	1	01	01	H2663_006_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					0.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.16	65.00	130.00	195.00					3.16	95.00	190.00	285.00					2.16	65.00	130.00	195.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	10	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					0.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2663	015	0	1	02	01	H2663_015_0	10	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.40	12.00	24.00	36.00					0.13	4.00	8.00	12.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					0.16	5.00	10.00	15.00					0.00	0.00	0.00	0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	10	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.00	30.00	60.00	90.00					1.50	45.00	90.00	135.00					1.00	30.00	60.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	10	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_001_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.13	4.00	8.00	12.00					.23	7.00	14.00	21.00					.13	4.00	8.00	12.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					.50	15.00	30.00	45.00					.33	10.00	20.00	30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_001_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_001_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	017	0	1	02	01	H2667_017_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.16	5.00	10.00	15.00					.26	8.00	16.00	24.00					.16	5.00	10.00	12.50																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	017	0	1	02	01	H2667_017_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					.50	15.00	30.00	45.00					.33	10.00	20.00	30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	017	0	1	02	01	H2667_017_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	017	0	1	02	01	H2667_017_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	017	0	1	02	01	H2667_017_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	001	0	1	01	01	H2672_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	001	0	1	01	01	H2672_001_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	001	0	1	01	01	H2672_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					1.10	33.00	66.00	99.00					.33	10.00	20.00	30.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	001	0	1	01	01	H2672_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.20	6.00	12.00	18.00					.30	9.00	18.00	27.00					.20	6.00	12.00	15.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	001	0	1	01	01	H2672_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					1.10	33.00	66.00	99.00					.33	10.00	20.00	30.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.20	6.00	12.00	18.00					.30	9.00	18.00	27.00					.20	6.00	12.00	15.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	009	0	1	01	01	H2672_009_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.73	82.00	164.00	246.00					3.16	95.00	190.00	285.00					2.73	82.00	164.00	246.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	009	0	1	01	01	H2672_009_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	009	0	1	01	01	H2672_009_0	4	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.20	36.00	72.00	108.00					1.50	45.00	90.00	135.00					1.20	36.00	72.00	108.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	009	0	1	01	01	H2672_009_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.30	9.00	18.00	27.00					1.10	33.00	66.00	99.00					.30	9.00	18.00	27.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	009	0	1	01	01	H2672_009_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.20	6.00	12.00	18.00					.30	9.00	18.00	27.00					.20	6.00	12.00	15.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	010	0	1	01	01	H2672_010_0	5	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	010	0	1	01	01	H2672_010_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	010	0	1	01	01	H2672_010_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	010	0	1	01	01	H2672_010_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					.50	15.00	30.00	45.00					.33	10.00	20.00	30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	010	0	1	01	01	H2672_010_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.20	6.00	12.00	18.00					.30	9.00	18.00	27.00					.20	6.00	0.00	0.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	012	0	1	01	01	H2672_012_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	012	0	1	01	01	H2672_012_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	012	0	1	01	01	H2672_012_0	4	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	012	0	1	01	01	H2672_012_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					1.10	33.00	66.00	99.00					.33	10.00	20.00	30.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	012	0	1	01	01	H2672_012_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.20	6.00	12.00	18.00					.30	9.00	18.00	27.00					.20	6.00	0.00	0.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2676	001	0	1	04	01	H2676_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.23	7.00	14.00	21.00																					0.23	7.00		12.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2676	001	0	1	04	01	H2676_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.36	11.00	22.00	33.00																					0.36	11.00		24.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2676	001	0	1	04	01	H2676_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.33	40.00	80.00	120.00																					1.33	40.00		110.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2676	001	0	1	04	01	H2676_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2676	001	0	1	04	01	H2676_001_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					596.20	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	001	0	1	04	01	H2701_001_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	35.00	70.00	87.50																					0.00	35.00	70.00	87.50																		35.00				0.00	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	001	0	1	04	01	H2701_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	70.00	140.00	210.00																					0.00	70.00	140.00	210.00																		70.00				0.00	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	001	0	1	04	01	H2701_001_0	7	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	34							34						34		34					528.17	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	001	0	1	04	01	H2701_001_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2701	001	0	1	04	01	H2701_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	5.00	10.00	10.00																					0.00	5.00	10.00	10.00																		5.00				0.00	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	001	0	1	04	01	H2701_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	001	0	1	04	01	H2701_001_0	7	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	5.00	10.00	10.00																					0.00	5.00	10.00	10.00																		5.00				0.00	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2701	003	0	1	04	01	H2701_003_0	10	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	34							34						34		34					452.73	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	003	0	1	04	01	H2701_003_0	10	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	20.00	40.00	40.00																					0.00	20.00	40.00	40.00																		20.00				0.00	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	003	0	1	04	01	H2701_003_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	45.00	90.00	112.50																					0.00	45.00	90.00	112.50																		45.00				0.00	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	003	0	1	04	01	H2701_003_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	80.00	160.00	240.00																					0.00	80.00	160.00	240.00																		80.00				0.00	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	003	0	1	04	01	H2701_003_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	5.00	10.00	10.00																					0.00	5.00	10.00	10.00																		5.00				0.00	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	004	0	1	04	01	H2701_004_0	6	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	34							34						34		34					528.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	004	0	1	04	01	H2701_004_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	40.00	80.00	100.00																					0.00	40.00	80.00	100.00																		40.00				0.00	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	004	0	1	04	01	H2701_004_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	75.00	150.00	225.00																					0.00	75.00	150.00	225.00																		75.00				0.00	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	004	0	1	04	01	H2701_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	15.00	30.00	30.00																					0.00	15.00	30.00	30.00																		15.00				0.00	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	004	0	1	04	01	H2701_004_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	005	0	1	04	01	H2701_005_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	40.00	80.00	100.00																					0.00	40.00	80.00	100.00																		40.00				0.00	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	005	0	1	04	01	H2701_005_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	75.00	150.00	225.00																					0.00	75.00	150.00	225.00																		75.00				0.00	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	005	0	1	04	01	H2701_005_0	5	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	34							34						34		34					497.10	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	005	0	1	04	01	H2701_005_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	15.00	30.00	30.00																					0.00	15.00	30.00	30.00																		15.00				0.00	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	005	0	1	04	01	H2701_005_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	006	0	1	04	01	H2701_006_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	25.00	50.00	50.00																					0.00	25.00	50.00	50.00																		25.00				0.00	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	006	0	1	04	01	H2701_006_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	45.00	90.00	112.50																					0.00	45.00	90.00	112.50																		45.00				0.00	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	006	0	1	04	01	H2701_006_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	10.00	20.00	20.00																					0.00	10.00	20.00	20.00																		10.00				0.00	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	006	0	1	04	01	H2701_006_0	5	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	34							34						34		34					600.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	006	0	1	04	01	H2701_006_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	0.00	90.00	180.00	270.00																					0.00	90.00	180.00	270.00																		90.00				0.00	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	002	0	1	01	01	H2758_002_0	8	1	Preferred Generic	3	4	001000	1	2	111		01	100		1	31	62	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2758	002	0	1	01	01	H2758_002_0	8	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	62	90				1			90				31		31					333.33	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	002	0	1	01	01	H2758_002_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	62	90				1			90				31		31	1.61	55.00	110.00	165.00																								165.00																		55.00				1.61	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	002	0	1	01	01	H2758_002_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	62	90				1			90				31		31	.73	25.00	50.00	75.00																								75.00																		25.00				.43	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	002	0	1	01	01	H2758_002_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	62	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	002	0	1	01	01	H2758_002_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	62	90				1			90				31		31	.20	7.00	14.00	21.00																								21.00																		7.00				.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	7	5	Specialty Tier	1	4	110000	1	1	010		01	010		1	31							31						31		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	7	4	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	31		90				1	31		90				31		31	1.77	55.00		165.00																					1.77	55.00		165.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	7	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	.97	30.00		90.00																					.97	30.00		90.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	013	0	1	01	01	H2773_013_0	7	5	Specialty Tier	1	4	110000	1	1	010		01	010		1	31							31						31		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	013	0	1	01	01	H2773_013_0	7	4	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	31		90				1	31		90				31		31	1.77	55.00		165.00																					1.77	55.00		165.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	013	0	1	01	01	H2773_013_0	7	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	.97	30.00		90.00																					.97	30.00		90.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	013	0	1	01	01	H2773_013_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.48	15.00		45.00																					.48	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	013	0	1	01	01	H2773_013_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.13	4.00		12.00																					.13	4.00		8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	013	0	1	01	01	H2773_013_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.13	4.00		12.00																					.13	4.00		8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	015	0	1	01	01	H2773_015_0	6	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	.97	30.00		90.00																					.97	30.00		90.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	015	0	1	01	01	H2773_015_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	015	0	1	01	01	H2773_015_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	015	0	1	01	01	H2773_015_0	6	4	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	31		90				1	31		90				31		31	1.77	55.00		165.00																					1.77	55.00		165.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	015	0	1	01	01	H2773_015_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.13	4.00		12.00																					.13	4.00		8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	015	0	1	01	01	H2773_015_0	6	5	Specialty Tier	1	4	110000	1	1	010		01	010		1	31							31						31		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	6	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	.97	30.00		90.00																					.97	30.00		90.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	6	4	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	31		90				1	31		90				31		31	1.77	55.00		165.00																					1.77	55.00		165.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	6	5	Specialty Tier	1	4	110000	1	1	010		01	010		1	31							31						31		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	018	0	1	01	01	H2773_018_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	5	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	.97	30.00		90.00																					.97	30.00		90.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	5	5	Specialty Tier	1	4	110000	1	1	010		01	010		1	31							31						31		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	5	4	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	31		90				1	31		90				31		31	1.77	55.00		165.00																					1.77	55.00		165.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	019	0	1	01	01	H2773_019_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.13	4.00		12.00																					.13	4.00		8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	019	0	1	01	01	H2773_019_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.48	15.00		45.00																					.48	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	019	0	1	01	01	H2773_019_0	6	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	.97	30.00		90.00																					.97	30.00		90.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	019	0	1	01	01	H2773_019_0	6	4	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	31		90				1	31		90				31		31	1.77	55.00		165.00																					1.77	55.00		165.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	019	0	1	01	01	H2773_019_0	6	5	Specialty Tier	1	4	110000	1	1	010		01	010		1	31							31						31		31						33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	7	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	084	0	1	04	01	H2775_084_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	084	0	1	04	01	H2775_084_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	084	0	1	04	01	H2775_084_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	084	0	1	04	01	H2775_084_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	084	0	1	04	01	H2775_084_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	085	0	1	04	01	H2775_085_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	085	0	1	04	01	H2775_085_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	085	0	1	04	01	H2775_085_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	085	0	1	04	01	H2775_085_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	085	0	1	04	01	H2775_085_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	7	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	7	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	091	0	1	04	01	H2775_091_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	091	0	1	04	01	H2775_091_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	091	0	1	04	01	H2775_091_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	091	0	1	04	01	H2775_091_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	091	0	1	04	01	H2775_091_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	098	0	1	04	01	H2775_098_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	098	0	1	04	01	H2775_098_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	098	0	1	04	01	H2775_098_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	098	0	1	04	01	H2775_098_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	098	0	1	04	01	H2775_098_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					597.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2810	001	0	1	04	01	H2810_001_0	6	4	Non-Preferred Brand	1	3	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					88.20	50	50	50																					50	50	50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2810	001	0	1	04	01	H2810_001_0	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.36	11.00	22.00	33.00																					0.36	11.00	22.00	33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2810	001	0	1	04	01	H2810_001_0	6	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.07	2.00	4.00	6.00																					0.07	2.00	4.00	6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2810	001	0	1	04	01	H2810_001_0	6	2	Non-Preferred Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.28	10.00	20.00	30.00																					0.28	10.00	20.00	30.00																		10.00				0.28	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H2816	013	0	1	09	04	H2816_013_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	7	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	021	0	1	09	04	H2816_021_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	021	0	1	09	04	H2816_021_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	021	0	1	09	04	H2816_021_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	021	0	1	09	04	H2816_021_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	021	0	1	09	04	H2816_021_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	022	0	1	09	04	H2816_022_0	6	2	Non-Preferred Generic	1	3	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	022	0	1	09	04	H2816_022_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	022	0	1	09	04	H2816_022_0	6	4	Non-Preferred Brand	1	3	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	022	0	1	09	04	H2816_022_0	6	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	022	0	1	09	04	H2816_022_0	6	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	027	0	1	09	04	H2816_027_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	027	0	1	09	04	H2816_027_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	027	0	1	09	04	H2816_027_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	027	0	1	09	04	H2816_027_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	027	0	1	09	04	H2816_027_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	028	0	1	09	04	H2816_028_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	028	0	1	09	04	H2816_028_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	028	0	1	09	04	H2816_028_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	028	0	1	09	04	H2816_028_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	028	0	1	09	04	H2816_028_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2836	001	0	1	04	01	H2836_001_0	6	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H2836	001	0	1	04	01	H2836_001_0	6	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H2836	001	0	1	04	01	H2836_001_0	6	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H2836	001	0	1	04	01	H2836_001_0	6	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H2836	001	0	1	04	01	H2836_001_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.56	19.00	38.00	57.00					.71	24.00	48.00	72.00					.56	19.00	38.00	38.00																		24.00				.71	24.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H2836	001	0	1	04	01	H2836_001_0	6	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H2905	001	0	1	04	01	H2905_001_0	8	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2905	001	0	1	04	01	H2905_001_0	8	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2905	001	0	1	04	01	H2905_001_0	8	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.23	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2905	001	0	1	04	01	H2905_001_0	8	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					614.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2905	001	0	1	04	01	H2905_001_0	8	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	003	0	1	04	01	H2906_003_0	8	6	Select Diabetic Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	003	0	1	04	01	H2906_003_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.06	2.00		5.00																								5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2906	003	0	1	04	01	H2906_003_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		10.00																								10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2906	003	0	1	04	01	H2906_003_0	8	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		200.00																								200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2906	003	0	1	04	01	H2906_003_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					264.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	003	0	1	04	01	H2906_003_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.33	70.00		175.00																								140.00																		70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	003	0	1	04	01	H2906_003_0	8	6	Select Diabetic Drugs	3	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	.66	20.00		50.00																								50.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2906	003	0	1	04	01	H2906_003_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		10.00																								8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	003	0	1	04	01	H2906_003_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.06	2.00		5.00																								4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	003	0	1	04	01	H2906_003_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.33	40.00		100.00																								80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	005	0	1	04	01	H2906_005_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		200.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	005	0	1	04	01	H2906_005_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		112.50																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	005	0	1	04	01	H2906_005_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.20	6.00		15.00																								12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	005	0	1	04	01	H2906_005_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.06	2.00		5.00																								4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	005	0	1	04	01	H2906_005_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					264.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	005	0	1	04	01	H2906_005_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.20	6.00		15.00																								12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2906	005	0	1	04	01	H2906_005_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.06	2.00		5.00																								4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2906	005	0	1	04	01	H2906_005_0	8	6	Select Diabetic Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	006	0	1	04	01	H2906_006_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		10.00																								8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	006	0	1	04	01	H2906_006_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	006	0	1	04	01	H2906_006_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2906	006	0	1	04	01	H2906_006_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		10.00																								8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2906	006	0	1	04	01	H2906_006_0	8	6	Select Diabetic Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	006	0	1	04	01	H2906_006_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					264.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	006	0	1	04	01	H2906_006_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		200.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	006	0	1	04	01	H2906_006_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		112.50																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	007	0	1	04	01	H2906_007_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		10.00																								8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	007	0	1	04	01	H2906_007_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					264.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	007	0	1	04	01	H2906_007_0	6	6	Select Diabetic Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	007	0	1	04	01	H2906_007_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		10.00																								8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2906	007	0	1	04	01	H2906_007_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		200.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	007	0	1	04	01	H2906_007_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		112.50																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	007	0	1	04	01	H2906_007_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2906	007	0	1	04	01	H2906_007_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2911	001	0	1	02	01	H2911_001_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					.09	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2911	001	0	1	02	01	H2911_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.32	10.00	20.00	30.00																					.32	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2911	001	0	1	02	01	H2911_001_0	8	5	Specialty Tier	1	4	100000	1	1	010		01	010		1	31							31						31		31					514.02	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2911	001	0	1	02	01	H2911_001_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2911	001	0	1	02	01	H2911_001_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	8	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	8	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.26	38.00		114.00																															104.00							114.00				38.00				1.22	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	8	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	8	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					757.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	8	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2931	002	0	1	01	01	H2931_002_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2931	004	0	1	01	01	H2931_004_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.20	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					660.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	004	0	1	09	04	H2944_004_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	004	0	1	09	04	H2944_004_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	004	0	1	09	04	H2944_004_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	004	0	1	09	04	H2944_004_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	004	0	1	09	04	H2944_004_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	26																														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	9	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	9	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.46	14.00		42.00																												0.46	14.00		0.00				0.46	14.00		42.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	9	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	9	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	9	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	013	0	1	09	04	H2944_013_0	9	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2944	013	0	1	09	04	H2944_013_0	9	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.46	14.00		42.00																												0.46	14.00		0.00				0.46	14.00		42.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	013	0	1	09	04	H2944_013_0	9	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	9	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	013	0	1	09	04	H2944_013_0	9	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	024	0	1	09	04	H2944_024_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	024	0	1	09	04	H2944_024_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2944	024	0	1	09	04	H2944_024_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	024	0	1	09	04	H2944_024_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	024	0	1	09	04	H2944_024_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	024	0	1	09	04	H2944_024_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	024	0	1	09	04	H2944_024_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	024	0	1	09	04	H2944_024_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	024	0	1	09	04	H2944_024_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	024	0	1	09	04	H2944_024_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	041	0	1	09	04	H2944_041_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	041	0	1	09	04	H2944_041_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	041	0	1	09	04	H2944_041_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	041	0	1	09	04	H2944_041_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	041	0	1	09	04	H2944_041_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	041	0	1	09	04	H2944_041_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	041	0	1	09	04	H2944_041_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2944	041	0	1	09	04	H2944_041_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	041	0	1	09	04	H2944_041_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	041	0	1	09	04	H2944_041_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	078	0	1	09	04	H2944_078_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	078	0	1	09	04	H2944_078_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	078	0	1	09	04	H2944_078_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2944	078	0	1	09	04	H2944_078_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	078	0	1	09	04	H2944_078_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	078	0	1	09	04	H2944_078_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	078	0	1	09	04	H2944_078_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	078	0	1	09	04	H2944_078_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	078	0	1	09	04	H2944_078_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	078	0	1	09	04	H2944_078_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	085	0	1	09	04	H2944_085_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	085	0	1	09	04	H2944_085_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	085	0	1	09	04	H2944_085_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	085	0	1	09	04	H2944_085_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	085	0	1	09	04	H2944_085_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	6	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	6	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	6	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.56	17.00		51.00																												0.56	17.00		0.00				0.56	17.00		51.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	6	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2944	124	0	1	09	04	H2944_124_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	124	0	1	09	04	H2944_124_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	124	0	1	09	04	H2944_124_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	124	0	1	09	04	H2944_124_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	124	0	1	09	04	H2944_124_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2944	127	0	1	09	04	H2944_127_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	127	0	1	09	04	H2944_127_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	127	0	1	09	04	H2944_127_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	127	0	1	09	04	H2944_127_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	128	0	1	09	04	H2944_128_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	128	0	1	09	04	H2944_128_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	128	0	1	09	04	H2944_128_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	128	0	1	09	04	H2944_128_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2944	128	0	1	09	04	H2944_128_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	128	0	1	09	04	H2944_128_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	128	0	1	09	04	H2944_128_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	128	0	1	09	04	H2944_128_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	128	0	1	09	04	H2944_128_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	128	0	1	09	04	H2944_128_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	133	0	1	09	04	H2944_133_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	133	0	1	09	04	H2944_133_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	133	0	1	09	04	H2944_133_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	133	0	1	09	04	H2944_133_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	133	0	1	09	04	H2944_133_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	133	0	1	09	04	H2944_133_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2944	133	0	1	09	04	H2944_133_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	133	0	1	09	04	H2944_133_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	133	0	1	09	04	H2944_133_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	133	0	1	09	04	H2944_133_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	012	0	1	01	01	H2949_012_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	012	0	1	01	01	H2949_012_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	012	0	1	01	01	H2949_012_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	012	0	1	01	01	H2949_012_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2949	012	0	1	01	01	H2949_012_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.06	2.00		6.00																												0.06	2.00		0.00				0.06	2.00		6.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	012	0	1	01	01	H2949_012_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	012	0	1	01	01	H2949_012_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	012	0	1	01	01	H2949_012_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	012	0	1	01	01	H2949_012_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	012	0	1	01	01	H2949_012_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.06	2.00		6.00																												0.06	2.00		0.00				0.06	2.00		6.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2949	013	0	1	01	01	H2949_013_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	013	0	1	01	01	H2949_013_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	013	0	1	01	01	H2949_013_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	013	0	1	01	01	H2949_013_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	013	0	1	01	01	H2949_013_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
H2949	013	0	1	01	01	H2949_013_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	014	0	1	01	01	H2949_014_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	014	0	1	01	01	H2949_014_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	014	0	1	01	01	H2949_014_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H2949	014	0	1	01	01	H2949_014_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	014	0	1	01	01	H2949_014_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	004	0	1	01	01	H2960_004_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.26	8.00		20.00																								16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2960	004	0	1	01	01	H2960_004_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.10	3.00		7.50																								6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	004	0	1	01	01	H2960_004_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.10	3.00		7.50																								6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2960	004	0	1	01	01	H2960_004_0	9	6	Select Diabetic Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	004	0	1	01	01	H2960_004_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					264.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	004	0	1	01	01	H2960_004_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		200.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	004	0	1	01	01	H2960_004_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		112.50																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	004	0	1	01	01	H2960_004_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.26	8.00		20.00																								16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	010	0	1	01	01	H2960_010_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.06	2.00		5.00																								4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	010	0	1	01	01	H2960_010_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		10.00																								8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	010	0	1	01	01	H2960_010_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.33	40.00		100.00																								80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	010	0	1	01	01	H2960_010_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.33	70.00		175.00																								140.00																		70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	010	0	1	01	01	H2960_010_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					264.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	010	0	1	01	01	H2960_010_0	9	6	Select Diabetic Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	010	0	1	01	01	H2960_010_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.06	2.00		5.00																								5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2960	010	0	1	01	01	H2960_010_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		10.00																								10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2960	010	0	1	01	01	H2960_010_0	9	6	Select Diabetic Drugs	3	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	.66	20.00		50.00																								50.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2960	010	0	1	01	01	H2960_010_0	9	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		200.00																								200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2960	012	0	1	01	01	H2960_012_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2960	012	0	1	01	01	H2960_012_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		10.00																								8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2960	012	0	1	01	01	H2960_012_0	9	6	Select Diabetic Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	012	0	1	01	01	H2960_012_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					264.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	012	0	1	01	01	H2960_012_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		200.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	012	0	1	01	01	H2960_012_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		112.50																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	012	0	1	01	01	H2960_012_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		10.00																								8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	012	0	1	01	01	H2960_012_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	018	0	1	01	01	H2960_018_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.06	2.00		5.00																								4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2960	018	0	1	01	01	H2960_018_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.20	6.00		15.00																								12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2960	018	0	1	01	01	H2960_018_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					264.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	018	0	1	01	01	H2960_018_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		200.00																								160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	018	0	1	01	01	H2960_018_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		112.50																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	018	0	1	01	01	H2960_018_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.20	6.00		15.00																								12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	018	0	1	01	01	H2960_018_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.06	2.00		5.00																								4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2960	018	0	1	01	01	H2960_018_0	9	6	Select Diabetic Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		25.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2962	001	0	1	01	01	H2962_001_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	10	2	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	.58	20.00		60.00																								40.00																		20.00				.58	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	10	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.47	50.00		150.00																								100.00																		50.00				1.47	50.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	10	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					76.64	33		33																							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	001	0	1	01	01	H2962_001_0	10	2	Preferred Brand	3	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	.58	20.00		60.00																								40.00																		20.00				.58	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2962	002	0	1	01	01	H2962_002_0	10	2	Preferred Brand	3	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	.29	10.00		30.00																								20.00																		10.00				.29	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2962	002	0	1	01	01	H2962_002_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	10	2	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	.29	10.00		30.00																								20.00																		10.00				.29	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	10	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.32	45.00		135.00																								90.00																		45.00				1.32	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	10	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					153.06	33		33																							33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3054	002	0	1	01	01	H3054_002_0	11	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	90				1	31	62	90				31		31	1.93	60.00	120.00	180.00																					1.93	60.00	120.00	180.00																		60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	002	0	1	01	01	H3054_002_0	11	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	62	90				1	31	62	90				31		31	0.25	8.00	16.00	24.00																					0.25	8.00	16.00	24.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3054	002	0	1	01	01	H3054_002_0	11	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	62	90				1	31	62	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3054	002	0	1	01	01	H3054_002_0	11	5	Specialty Tier	1	4	100000	1	1	010		01	010		1	31							31						31		31					100.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	002	0	1	01	01	H3054_002_0	11	3	Preferred Brand	1	4	000001	3	2	111		01	111		1	31	62	90				1	31	62	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	002	0	1	01	01	H3054_002_0	11	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	90				1	31	62	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	002	0	1	01	01	H3054_002_0	11	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	90				1	31	62	90				31		31	.25	8.00	16.00	24.00																					0.25	8.00	16.00	24.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3067	001	0	1	48	05	H3067_001_0	12	1	Generic Drugs	1	4	010000			110		01	100		1	34		90				2			90				34		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H3067	001	0	1	48	05	H3067_001_0	12	2	Brand Drugs	1	4	000010			110		01	100		1	34		90				2			90				34		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H3067	001	0	1	48	05	H3067_001_0	12	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		01			1	34													34		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H3071	002	0	1	01	01	H3071_002_0	10	2	Brand	1	4	000010	1	1	110		01	100		1	30		90				1			90				30		31					41.99	25		25																							25																	25				25	Generic, Brand												
H3071	002	0	1	01	01	H3071_002_0	10	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	.16	5.00		15.00																								15.00																		5.00				.16	5.00		Generic, Brand												
H3107	004	0	1	01	01	H3107_004_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	004	0	1	01	01	H3107_004_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					607.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	004	0	1	01	01	H3107_004_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	004	0	1	01	01	H3107_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	004	0	1	01	01	H3107_004_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	012	0	1	01	01	H3107_012_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	012	0	1	01	01	H3107_012_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					594.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	012	0	1	01	01	H3107_012_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	012	0	1	01	01	H3107_012_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	012	0	1	01	01	H3107_012_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3132	001	0	1	01	01	H3132_001_0	5	3	Non-Preferred Brand	1	2	100000	1	1	010		01			1	30													30		34					2000.00	25																																										25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H3132	001	0	1	01	01	H3132_001_0	5	2	Preferred Brand	1	2	010001	1	1	110		01			1	30		90				1							30		34					2000.00	25		25																																								25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H3132	001	0	1	01	01	H3132_001_0	5	1	Preferred Generic	1	2	001001	1	1	110		01			1	30		90				1							30		34					2000.00	25		25																																								25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H3144	001	0	1	01	01	H3144_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.66	80.00	160.00	240.00					3.16	95.00	190.00	285.00					2.66	80.00	160.00	240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	001	0	1	01	01	H3144_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	001	0	1	01	01	H3144_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					0.33	10.00	20.00	30.00					0.00	0.00	0.00	0.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	001	0	1	01	01	H3144_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.23	7.00	14.00	21.00					1.10	33.00	66.00	99.00					0.23	7.00	14.00	21.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	001	0	1	01	01	H3144_001_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	80.00	120.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	002	0	1	01	01	H3144_002_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					0.33	10.00	20.00	30.00					0.00	0.00	0.00	0.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	002	0	1	01	01	H3144_002_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.23	7.00	14.00	21.00					1.10	33.00	66.00	99.00					0.23	7.00	14.00	21.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	002	0	1	01	01	H3144_002_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	80.00	120.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	002	0	1	01	01	H3144_002_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.66	80.00	160.00	240.00					3.16	95.00	190.00	285.00					2.66	80.00	160.00	240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	002	0	1	01	01	H3144_002_0	8	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	003	0	1	01	01	H3144_003_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.23	7.00	14.00	21.00					0.33	10.00	20.00	30.00					0.23	7.00	14.00	21.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	003	0	1	01	01	H3144_003_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.83	25.00	50.00	75.00					1.10	33.00	66.00	99.00					0.83	25.00	50.00	75.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	003	0	1	01	01	H3144_003_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	003	0	1	01	01	H3144_003_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3144	003	0	1	01	01	H3144_003_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	6	3	Non-Preferred Brand	1	3	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	022	0	1	01	01	H3152_022_0	6	5	Select Care Drugs	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.13	4.00	8.00	12.00					4.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	022	0	1	01	01	H3152_022_0	6	4	Specialty Tier	1	3	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	022	0	1	01	01	H3152_022_0	6	2	Preferred Brand	1	3	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.40	42.00	84.00	126.00																												1.40	42.00	84.00	84.00				1.40	42.00	84.00	126.00					42.00			1.35	42.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	022	0	1	01	01	H3152_022_0	6	1	Generic	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	046	0	1	01	01	H3152_046_0	6	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.26	8.00	16.00	24.00					8.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	046	0	1	01	01	H3152_046_0	6	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	046	0	1	01	01	H3152_046_0	6	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	046	0	1	01	01	H3152_046_0	6	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	046	0	1	01	01	H3152_046_0	6	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.26	8.00	16.00	24.00																												.26	8.00	16.00	16.00				.26	8.00	16.00	24.00					8.00			.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	046	0	1	01	01	H3152_046_0	6	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.26	8.00	16.00	24.00					8.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3152	048	0	1	01	01	H3152_048_0	6	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	048	0	1	01	01	H3152_048_0	6	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	048	0	1	01	01	H3152_048_0	6	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.26	8.00	16.00	24.00					8.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	048	0	1	01	01	H3152_048_0	6	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.26	8.00	16.00	24.00					8.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3152	048	0	1	01	01	H3152_048_0	6	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.26	8.00	16.00	24.00																												.26	8.00	16.00	16.00				.26	8.00	16.00	24.00					8.00			.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	048	0	1	01	01	H3152_048_0	6	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	077	0	1	01	01	H3152_077_0	6	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	077	0	1	01	01	H3152_077_0	6	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	077	0	1	01	01	H3152_077_0	6	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	077	0	1	01	01	H3152_077_0	6	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	077	0	1	01	01	H3152_077_0	6	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3152	077	0	1	01	01	H3152_077_0	6	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3154	004	0	1	01	01	H3154_004_0	10	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	10	5	Specialty Tier	1	2	010010	1	1	010		01			1	30													30		31						25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	10	4	Non-Preferred Brand	1	2	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.80	84.00	168.00	252.00																					2.80	84.00	168.00	252.00																		84.00				2.70	84.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	10	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.40	42.00	84.00	126.00																					1.40	42.00	84.00	126.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	10	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.50	15.00	30.00	45.00																					0.25	7.50	15.00	22.50																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8	4	Non-Preferred Brand	1	2	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.80	84.00	168.00	252.00																					2.80	84.00	168.00	252.00																		84.00				2.70	84.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.50	15.00	30.00	45.00																					0.25	7.50	15.00	22.50																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8	5	Specialty Tier	1	2	010010	1	1	010		01			1	30													30		31						25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.40	42.00	84.00	126.00																					1.40	42.00	84.00	126.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	030	0	1	01	01	H3156_030_0	7	5	Specialty Tier	1	4	101101	1	1	110		01	100		1	30		90				1			90				30		31					456.18	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	030	0	1	01	01	H3156_030_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	030	0	1	01	01	H3156_030_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.30	9.00		27.00																								18.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	030	0	1	01	01	H3156_030_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	030	0	1	01	01	H3156_030_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	032	0	1	01	01	H3156_032_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.30	9.00		27.00																								18.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	032	0	1	01	01	H3156_032_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	032	0	1	01	01	H3156_032_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	032	0	1	01	01	H3156_032_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	032	0	1	01	01	H3156_032_0	7	5	Specialty Tier	1	4	101101	1	1	110		01	100		1	30		90				1			90				30		31					456.18	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	034	0	1	01	01	H3156_034_0	7	5	Specialty Tier	1	4	101101	1	1	110		01	100		1	30		90				1			90				30		31					456.18	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	034	0	1	01	01	H3156_034_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	034	0	1	01	01	H3156_034_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.30	9.00		27.00																								18.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	034	0	1	01	01	H3156_034_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	034	0	1	01	01	H3156_034_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	9	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	9	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					868.06	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	9	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					868.06	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	9	1	Preferred Generic	3	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3204	007	0	1	01	01	H3204_007_0	9	2	Non-Preferred Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3204	007	0	1	01	01	H3204_007_0	9	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	9	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	9	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					891.67	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	9	1	Preferred Generic	3	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3206	002	0	1	04	01	H3206_002_0	9	2	Non-Preferred Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3206	002	0	1	04	01	H3206_002_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	9	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					891.67	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	9	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3237	001	0	1	48	05	H3237_001_0	5	3	Non-Medicare Rx/OTC Drugs	1	4	010010			111		01	111		1	30	60	90				1	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3237	001	0	1	48	05	H3237_001_0	5	1	Generic Drugs	1	4	010000			111		01	111		1	30	60	90				1	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H3237	001	0	1	48	05	H3237_001_0	5	2	Brand Drugs	1	4	000010			111		01	111		1	30	60	90				1	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H3237	002	0	1	48	05	H3237_002_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			111		01	111		1	30	60	90				1	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3237	002	0	1	48	05	H3237_002_0	4	2	Brand Drugs	1	4	000010			111		01	111		1	30	60	90				1	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H3237	002	0	1	48	05	H3237_002_0	4	1	Generic Drugs	1	4	010000			111		01	111		1	30	60	90				1	30	60	90				30		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H3251	002	0	1	01	01	H3251_002_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	3.00	90.00		270.00																								270.00																			90.00			2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	10	5	Specialty Tier	1	4	000010	1	1	110		10	100		1	30		90				1			90					29	31						33		33																							33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	10	1	Preferred Generic	3	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	0.00	0.00		0.00																								0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	002	0	1	01	01	H3251_002_0	10	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	1.50	45.00		135.00																								135.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	.13	4.00		12.00																								12.00																			4.00			.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	002	0	1	01	01	H3251_002_0	10	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	0.00	0.00		0.00																								0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	.13	4.00		12.00																								12.00																			4.00			.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	2.83	85.00		255.00																								255.00																			85.00			2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	0.00	0.00		0.00																								0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	.23	7.00		21.00																								21.00																			7.00			.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	1.33	40.00		120.00																								120.00																			40.00			1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	5	Specialty Tier	1	4	000010	1	4	110		10	100		1	30		90				1			90					29	31	11.67	350.00		1050.00	350.00	33		33																				1050.00			33																350.00		33	11.29	350.00	33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	1	Preferred Generic	3	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	0.00	0.00		0.00																								0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	021	0	1	02	01	H3251_021_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	.23	7.00		21.00																								21.00																			7.00			.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	024	0	1	01	01	H3251_024_0	12	1	Preferred Generic	3	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	0.00	0.00		0.00																								0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	024	0	1	01	01	H3251_024_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	2.67	80.00		240.00																								240.00																			80.00			2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	024	0	1	01	01	H3251_024_0	12	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	1.33	40.00		120.00																								120.00																			40.00			1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	024	0	1	01	01	H3251_024_0	12	2	Non-Preferred Generic	3	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	.23	7.00		21.00																								21.00																			7.00			.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	024	0	1	01	01	H3251_024_0	12	5	Specialty Tier	1	4	000010	1	4	110		10	100		1	30		90				1			90					29	31	11.67	350.00		1050.00	350.00	33		33																				1050.00			33																350.00		33	11.29	350.00	33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	024	0	1	01	01	H3251_024_0	12	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	0.00	0.00		0.00																								0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	024	0	1	01	01	H3251_024_0	12	2	Non-Preferred Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	.23	7.00		21.00																								21.00																			7.00			.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	027	0	1	01	01	H3251_027_0	7	5	Specialty Tier	1	2	000010	1	1	110		10	100		1	30		90				1			90					29	31						25		25																							25																		25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	027	0	1	01	01	H3251_027_0	7	4	Non-Preferred Brand	1	2	100000	1	2	110		10	100		1	30		90				1			90					29	31	3.17	95.00		285.00																								285.00																			95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	027	0	1	01	01	H3251_027_0	7	3	Preferred Brand	1	2	000001	1	2	110		10	100		1	30		90				1			90					29	31	1.40	42.00		126.00																								126.00																			42.00			1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	027	0	1	01	01	H3251_027_0	7	1	Preferred Generic	1	2	001000	1	2	110		10	100		1	30		90				1			90					29	31	0.00	0.00		0.00																								0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	027	0	1	01	01	H3251_027_0	7	2	Non-Preferred Generic	1	2	000100	1	2	110		10	100		1	30		90				1			90					29	31	.23	7.00		21.00																								21.00																			7.00			.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3305	011	0	1	02	01	H3305_011_0	7	3	Non-Preferred Brand	1	4	100100	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3305	011	0	1	02	01	H3305_011_0	7	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					35.00	33																							33																			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3305	011	0	1	02	01	H3305_011_0	7	5	Select Care Drugs	1	4	010010	1	2	110		01	110		1	30		90				2	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3305	011	0	1	02	01	H3305_011_0	7	5	Select Care Drugs	3	4	010010	1	2	110		01	110		1	30		90				2	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3305	011	0	1	02	01	H3305_011_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3305	011	0	1	02	01	H3305_011_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.17	35.00		105.00																					1.17	35.00		70.00																		35.00				1.13	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3305	015	0	1	02	01	H3305_015_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3305	015	0	1	02	01	H3305_015_0	7	3	Non-Preferred Brand	1	4	100100	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3305	015	0	1	02	01	H3305_015_0	7	5	Select Care Drugs	1	4	010010	1	2	110		01	110		1	30		90				2	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3305	015	0	1	02	01	H3305_015_0	7	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					35.00	33																							33																			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3305	015	0	1	02	01	H3305_015_0	7	5	Select Care Drugs	3	4	010010	1	2	110		01	110		1	30		90				2	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3305	015	0	1	02	01	H3305_015_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.17	35.00		105.00																					1.17	35.00		70.00																		35.00				1.13	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3307	002	0	1	01	01	H3307_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					622.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.46	44.00		132.00																															122.00							132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					718.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					508.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.20	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.46	44.00		132.00																															122.00							132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	002	0	1	01	01	H3312_002_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	002	0	1	01	01	H3312_002_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	002	0	1	01	01	H3312_002_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	002	0	1	01	01	H3312_002_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	002	0	1	01	01	H3312_002_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3312	018	0	1	01	01	H3312_018_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	018	0	1	01	01	H3312_018_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	018	0	1	01	01	H3312_018_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	018	0	1	01	01	H3312_018_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	018	0	1	01	01	H3312_018_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	018	0	1	01	01	H3312_018_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3312	048	0	1	01	01	H3312_048_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	048	0	1	01	01	H3312_048_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	048	0	1	01	01	H3312_048_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	048	0	1	01	01	H3312_048_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3312	048	0	1	01	01	H3312_048_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	048	0	1	01	01	H3312_048_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	060	0	1	01	01	H3312_060_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	060	0	1	01	01	H3312_060_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	060	0	1	01	01	H3312_060_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	060	0	1	01	01	H3312_060_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	060	0	1	01	01	H3312_060_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	060	0	1	01	01	H3312_060_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3312	061	0	1	01	01	H3312_061_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	061	0	1	01	01	H3312_061_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	061	0	1	01	01	H3312_061_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	061	0	1	01	01	H3312_061_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	061	0	1	01	01	H3312_061_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3312	061	0	1	01	01	H3312_061_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3327	001	0	1	01	01	H3327_001_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.48	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	001	0	1	01	01	H3327_001_0	7	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								12.50																		5.00				.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	001	0	1	01	01	H3327_001_0	7	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.62	80.00		240.00																								200.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	001	0	1	01	01	H3327_001_0	7	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					254.58	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	6	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.31	40.00		120.00																								100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.62	80.00		240.00																								200.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					313.86	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	038	0	1	02	01	H3327_038_0	6	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	.20	6.00		18.00																								15.00																		6.00				.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	038	0	1	02	01	H3327_038_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.31	40.00		120.00																								100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	038	0	1	02	01	H3327_038_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					235.93	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	038	0	1	02	01	H3327_038_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.62	80.00		240.00																								200.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	040	0	1	01	01	H3327_040_0	6	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								12.50																		5.00				.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	040	0	1	01	01	H3327_040_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.48	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	040	0	1	01	01	H3327_040_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.62	80.00		240.00																								200.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	040	0	1	01	01	H3327_040_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					216.32	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	041	0	1	01	01	H3327_041_0	7	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	041	0	1	01	01	H3327_041_0	7	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.62	80.00		240.00																								200.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	041	0	1	01	01	H3327_041_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.31	40.00		120.00																								100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	041	0	1	01	01	H3327_041_0	7	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					320.67	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	6	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	30		90				1			90				30		34	0.53	16.00		48.00																								32.00																		16.00				0.47	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	6	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	30		90				1			90				30		34	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	6	3	Preferred Brand	1	2	000001	1	2	110		01	100		1	30		90				1			90				30		34	1.50	45.00		135.00																								90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	6	5	Specialty Tier	1	2	010010	1	1	110		01	100		1	30		90				1			90				30		34						25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	6	4	Non-Preferred Brand	1	2	100000	1	2	110		01	100		1	30		90				1			90				30		34	3.16	95.00		285.00																								190.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	10	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		34	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	10	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		34	0.50	15.00		45.00																								30.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	10	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		34	1.16	35.00		105.00																								70.00																		35.00				1.02	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	10	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		34	3.16	95.00		285.00																								190.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	10	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				1			90				30		34						25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	6	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	30		90				1			90				30		34	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	6	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	30		90				1			90				30		34	0.96	29.00		87.00																								58.00																		29.00				0.85	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	6	3	Preferred Brand	1	2	000001	1	2	110		01	100		1	30		90				1			90				30		34	1.50	45.00		135.00																								90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	6	4	Non-Preferred Brand	1	2	100000	1	2	110		01	100		1	30		90				1			90				30		34	3.16	95.00		285.00																								190.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	6	5	Specialty Tier	1	2	010010	1	1	110		01	100		1	30		90				1			90				30		34						25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		34	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		34	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3328	017	0	1	01	01	H3328_017_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		34						25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		34	3.16	95.00		285.00																								190.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		34	1.50	45.00		135.00																								90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		34	0.76	23.00		69.00																								46.00																		23.00				0.67	23.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	019	0	1	01	01	H3328_019_0	10	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		34	3.16	95.00		285.00																								190.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	019	0	1	01	01	H3328_019_0	10	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		34	0.60	18.00		54.00																								36.00																		18.00				0.52	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	019	0	1	01	01	H3328_019_0	10	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		34	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	019	0	1	01	01	H3328_019_0	10	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		34	1.50	45.00		135.00																								90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	019	0	1	01	01	H3328_019_0	10	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				1			90				30		34					569.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					0.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	6	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					946.29	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					0.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	7	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					946.29	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					0.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	7	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					946.29	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	029	0	1	01	01	H3330_029_0	9	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	029	0	1	01	01	H3330_029_0	9	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.30	9.00	18.00	27.00																					.30	9.00	18.00	27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	029	0	1	01	01	H3330_029_0	9	4	Non-Preferred Brand	1	2	100000	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					103.33	30	30	30																					30	30	30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	029	0	1	01	01	H3330_029_0	9	3	Preferred Brand	1	2	000001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					50.84	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	029	0	1	01	01	H3330_029_0	9	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					907.36	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					0.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	8	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					1022.80	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	8	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					1022.80	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					0.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	8	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					1022.80	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					0.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	7	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					928.28	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					0.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					0.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	7	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					928.28	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	7	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					928.28	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					0.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	055	0	1	09	04	H3333_055_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	055	0	1	09	04	H3333_055_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	055	0	1	09	04	H3333_055_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	055	0	1	09	04	H3333_055_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	055	0	1	09	04	H3333_055_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	057	0	1	09	04	H3333_057_0	6	4	Non-Preferred Brand	1	3	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	057	0	1	09	04	H3333_057_0	6	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	057	0	1	09	04	H3333_057_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	057	0	1	09	04	H3333_057_0	6	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	057	0	1	09	04	H3333_057_0	6	2	Non-Preferred Generic	1	3	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	165	0	1	09	04	H3333_165_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	165	0	1	09	04	H3333_165_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	165	0	1	09	04	H3333_165_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	165	0	1	09	04	H3333_165_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	165	0	1	09	04	H3333_165_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	166	0	1	09	04	H3333_166_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	166	0	1	09	04	H3333_166_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	166	0	1	09	04	H3333_166_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	166	0	1	09	04	H3333_166_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3333	166	0	1	09	04	H3333_166_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	002	0	1	04	01	H3335_002_0	6	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		10.00																								10.00																		4.00				0.13	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	002	0	1	04	01	H3335_002_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	002	0	1	04	01	H3335_002_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	002	0	1	04	01	H3335_002_0	6	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	7	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		12.50																								12.50																		5.00				0.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	7	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		12.50																								12.50																		5.00				0.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	008	0	1	04	01	H3335_008_0	7	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	008	0	1	04	01	H3335_008_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	008	0	1	04	01	H3335_008_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	008	0	1	04	01	H3335_008_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		12.50																								12.50																		5.00				0.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	009	0	1	04	01	H3335_009_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		12.50																								12.50																		5.00				0.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	009	0	1	04	01	H3335_009_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	009	0	1	04	01	H3335_009_0	7	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	009	0	1	04	01	H3335_009_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		12.50																								12.50																		5.00				0.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	7	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	7	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		12.50																								12.50																		5.00				0.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	8	3	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	8	2	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	8	1	Generic	1	3	010000	1	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.26	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	8	4	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	021	0	1	04	01	H3335_021_0	8	1	Generic	1	3	010000	1	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		20.00																								20.00																		8.00				0.26	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	021	0	1	04	01	H3335_021_0	8	2	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	021	0	1	04	01	H3335_021_0	8	3	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	021	0	1	04	01	H3335_021_0	8	4	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	032	0	1	04	01	H3335_032_0	7	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	032	0	1	04	01	H3335_032_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		10.00																								10.00																		4.00				0.13	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	032	0	1	04	01	H3335_032_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	032	0	1	04	01	H3335_032_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	037	0	1	04	01	H3335_037_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.19	6.00		15.00																								15.00																		6.00				0.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	037	0	1	04	01	H3335_037_0	7	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	037	0	1	04	01	H3335_037_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	037	0	1	04	01	H3335_037_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	7	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.19	6.00		15.00																								15.00																		6.00				0.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	7	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.19	6.00		15.00																								15.00																		6.00				0.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	4	2	Non-Preferred Generic	1	4	000100	3	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.81	25.00	50.00	75.00																					0.81	25.00	50.00	75.00																		25.00				0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	4	4	Non-Preferred Brand	1	4	100000	3	2	111		01	111		1	31	60	90				2	31	60	90				31		31	2.42	75.00	150.00	225.00																					2.42	75.00	150.00	225.00																		75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	4	5	Specialty Tier	1	4	010010	3	1	010		01	010		1	31							31						31		31					467.89	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3337	001	0	1	01	01	H3337_001_0	4	2	Non-Preferred Generic	3	4	000100	3	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3342	001	0	1	04	01	H3342_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	001	0	1	04	01	H3342_001_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	001	0	1	04	01	H3342_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.21	7.00	14.00	21.00					.35	12.00	24.00	36.00					.21	7.00	14.00	14.00																		12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	001	0	1	04	01	H3342_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.21	7.00	14.00	21.00					.06	2.00	4.00	4.00																		7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	001	0	1	04	01	H3342_001_0	7	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	001	0	1	04	01	H3342_001_0	7	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	012	0	1	04	01	H3342_012_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.09	3.00	6.00	9.00					.24	8.00	16.00	24.00					.09	3.00	6.00	6.00																		8.00				.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	012	0	1	04	01	H3342_012_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.32	11.00	22.00	33.00					.47	16.00	32.00	48.00					.32	11.00	22.00	22.00																		16.00				.47	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	012	0	1	04	01	H3342_012_0	6	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	012	0	1	04	01	H3342_012_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	012	0	1	04	01	H3342_012_0	6	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	012	0	1	04	01	H3342_012_0	6	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	013	0	1	04	01	H3342_013_0	7	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	013	0	1	04	01	H3342_013_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	013	0	1	04	01	H3342_013_0	7	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	013	0	1	04	01	H3342_013_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	013	0	1	04	01	H3342_013_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.24	8.00	16.00	24.00					.38	13.00	26.00	39.00					.24	8.00	16.00	16.00																		13.00				.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	013	0	1	04	01	H3342_013_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.09	3.00	6.00	9.00					.24	8.00	16.00	24.00					.09	3.00	6.00	6.00																		8.00				.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	014	0	1	04	01	H3342_014_0	7	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	014	0	1	04	01	H3342_014_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	014	0	1	04	01	H3342_014_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	014	0	1	04	01	H3342_014_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.24	8.00	16.00	24.00					.38	13.00	26.00	39.00					.24	8.00	16.00	16.00																		13.00				.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	014	0	1	04	01	H3342_014_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.09	3.00	6.00	9.00					.24	8.00	16.00	24.00					.09	3.00	6.00	6.00																		8.00				.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3342	014	0	1	04	01	H3342_014_0	7	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	2	Non-Preferred Generic	3	4	000110	1	2	111		01	100		1	31	62	93				2			93				31		34	.22	7.00	14.00	17.50																								17.50																		7.00				.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3344	005	0	1	04	01	H3344_005_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	100		1	31	62	93				2			93				31		34	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3344	005	0	1	04	01	H3344_005_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	31													31		34					1023.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	4	Non-Preferred Brand	1	4	100100	3	2	111		01	100		1	31	62	93				2			93				31		34	2.41	75.00	150.00	187.50																								187.50																		75.00				2.20	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	3	Preferred Brand	1	4	000001	3	2	111		01	100		1	31	62	93				2			93				31		34	1.45	45.00	90.00	112.50																								112.50																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	62	93				2			93				31		34	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	2	Non-Preferred Generic	1	4	000110	1	2	111		01	100		1	31	62	93				2			93				31		34	0.22	7.00	14.00	17.50																								17.50																		7.00				.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	005	0	1	01	01	H3347_005_0	10	1	Generic	1	2	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	4.00		12.00																								10.00																		4.00				0.00	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	005	0	1	01	01	H3347_005_0	10	2	Preferred Brand	1	2	010001	1	2	110		01	100		1	30		90				2			90				30		31	0.00	40.00		120.00																								100.00																		40.00				0.00	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	005	0	1	01	01	H3347_005_0	10	3	Non-Preferred Brand	1	2	110000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	95.00		285.00																								237.50																		95.00				0.00	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	005	0	1	01	01	H3347_005_0	10	4	Specialty Tier	1	2	010010	1	1	110		01	100		1	30		90				2			90				30		31					402.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	6	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		10.00																								10.00																		4.00				0.13	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	6	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	6	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		10.00																								10.00																		4.00				0.13	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	6	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	6	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		10.00																								10.00																		4.00				0.13	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	6	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	6	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		12.50																								12.50																		5.00				0.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	6	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	6	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		10.00																								10.00																		4.00				0.13	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	6	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	6	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		10.00																								10.00																		4.00				0.13	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					1.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	6	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	3.06	95.00		237.50																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	12	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	12	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								113.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	12	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.00	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	12	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31						33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					2.74	85.00	170.00	255.00												1.29	40.00	80.00	80.00				2.74	85.00	170.00	255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					1.12	35.00	70.00	105.00												.48	15.00	30.00	30.00				1.12	35.00	70.00	105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.32	10.00	20.00	30.00												.06	2.00	4.00	4.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.12	4.00	8.00	12.00												0.00	0.00	0.00	0.00				.12	4.00	8.00	12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.12	4.00	8.00	12.00												0.00	0.00	0.00	0.00				.12	4.00	8.00	12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.32	10.00	20.00	30.00												.06	2.00	4.00	4.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.96	30.00	60.00	90.00												.48	15.00	30.00	30.00				.96	30.00	60.00	90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					2.48	77.00	154.00	231.00												1.29	40.00	80.00	80.00				2.48	77.00	154.00	231.00				77.00				2.48	77.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	098	0	1	01	01	H3361_098_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					2.74	85.00	170.00	255.00												1.29	40.00	80.00	80.00				2.74	85.00	170.00	255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	098	0	1	01	01	H3361_098_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					1.12	35.00	70.00	105.00												.48	15.00	30.00	30.00				1.12	35.00	70.00	105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	098	0	1	01	01	H3361_098_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.32	10.00	20.00	30.00												.06	2.00	4.00	4.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	098	0	1	01	01	H3361_098_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.12	4.00	8.00	12.00												0.00	0.00	0.00	0.00				.12	4.00	8.00	12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	098	0	1	01	01	H3361_098_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	02	01	H3361_099_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.32	10.00	20.00	30.00												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	02	01	H3361_099_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.09	3.00	6.00	9.00					.09	3.00	6.00	9.00												.09	3.00	6.00	0.00				.09	3.00	6.00	9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	02	01	H3361_099_0	5	3	Preferred Brand	1	4	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.41	44.00	88.00	132.00					1.41	44.00	88.00	132.00												1.41	44.00	88.00	88.00				1.41	44.00	88.00	132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	02	01	H3361_099_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.54	79.00	158.00	237.00					2.87	89.00	178.00	267.00												2.54	79.00	158.00	158.00				2.87	89.00	178.00	267.00				89.00				2.87	89.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	02	01	H3361_099_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.32	10.00	20.00	30.00												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	5	3	Preferred Brand	1	4	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.45	45.00	90.00	135.00					1.45	45.00	90.00	135.00												1.45	45.00	90.00	90.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.54	79.00	158.00	237.00					2.87	89.00	178.00	267.00												2.54	79.00	158.00	158.00				2.87	89.00	178.00	267.00				89.00				2.87	89.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.16	5.00	10.00	15.00					.61	19.00	38.00	57.00												.16	5.00	10.00	10.00				.61	19.00	38.00	57.00				19.00				.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.45	45.00	90.00	135.00					2.58	80.00	160.00	240.00												1.45	45.00	90.00	90.00				2.58	80.00	160.00	240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.64	20.00	40.00	60.00					1.29	40.00	80.00	120.00												.64	20.00	40.00	40.00				1.29	40.00	80.00	120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	6	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	6	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.25	70.00	140.00	210.00					2.90	90.00	180.00	270.00												2.25	70.00	140.00	140.00				2.90	90.00	180.00	270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	6	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	6	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.16	5.00	10.00	15.00					.32	10.00	20.00	30.00												.16	5.00	10.00	0.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.70	22.00	44.00	66.00												.48	15.00	30.00	30.00				.70	22.00	44.00	66.00				22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	02	01	H3361_132_0	5	3	Preferred Brand	1	4	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.41	44.00	88.00	132.00					1.41	44.00	88.00	132.00												1.41	44.00	88.00	88.00				1.41	44.00	88.00	132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	02	01	H3361_132_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.32	10.00	20.00	30.00												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	02	01	H3361_132_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.00	0.00	0.00	0.00												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	02	01	H3361_132_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.54	79.00	158.00	237.00					2.87	89.00	178.00	267.00												2.54	79.00	158.00	158.00				2.87	89.00	178.00	267.00				89.00				2.87	89.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	02	01	H3361_132_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	4	3	Preferred Brand	1	4	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.41	44.00	88.00	132.00					1.41	44.00	88.00	132.00												1.41	44.00	88.00	88.00				1.41	44.00	88.00	132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.32	10.00	20.00	30.00												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.09	3.00	6.00	9.00					.09	3.00	6.00	9.00												.09	3.00	6.00	0.00				.09	3.00	6.00	9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	4	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.54	79.00	158.00	237.00					2.87	89.00	178.00	267.00												2.54	79.00	158.00	158.00				2.87	89.00	178.00	267.00				89.00				2.87	89.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	6	2	Non-Preferred Generic	3	4	000110	1	2	111		01	100		1	31	62	93				2			93				31		34	.19	6.00	12.00	15.00																								15.00																		6.00				.17	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3362	017	0	1	01	01	H3362_017_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	100		1	31	62	93				2			93				31		34	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3362	017	0	1	01	01	H3362_017_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	31													31		34					1023.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	6	4	Non-Preferred Brand	1	4	100100	3	2	111		01	100		1	31	62	93				2			93				31		34	2.41	75.00	150.00	187.50																								187.50																		75.00				2.20	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	62	93				2			93				31		34	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	6	2	Non-Preferred Generic	1	4	000110	1	2	111		01	100		1	31	62	93				2			93				31		34	0.19	6.00	12.00	15.00																								15.00																		6.00				.17	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	6	3	Preferred Brand	1	4	000001	3	2	111		01	100		1	31	62	93				2			93				31		34	1.45	45.00	90.00	112.50																								112.50																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	6	2	Non-Preferred Generic	1	4	000110	1	2	111		01	100		1	31	62	93				2			93				31		34	0.16	5.00	10.00	12.50																								12.50																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	6	2	Non-Preferred Generic	3	4	000110	1	2	111		01	100		1	31	62	93				2			93				31		34	.16	5.00	10.00	12.50																								12.50																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3362	020	0	1	01	01	H3362_020_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	100		1	31	62	93				2			93				31		34	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3362	020	0	1	01	01	H3362_020_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	31													31		34					774.81	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	6	4	Non-Preferred Brand	1	4	100100	3	1	111		01	100		1	31	62	93				2			93				31		34					54.42	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	6	3	Preferred Brand	1	4	000001	3	1	111		01	100		1	31	62	93				2			93				31		34					67.06	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	62	93				2			93				31		34	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	025	0	1	01	01	H3362_025_0	8	4	Non-Preferred Brand	1	4	100100	3	1	111		01	100		1	31	62	93				2			93				31		34					54.42	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	025	0	1	01	01	H3362_025_0	8	2	Non-Preferred Generic	3	4	000110	1	1	111		01	100		1	31	62	93				2			93				31		34					7.27	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3362	025	0	1	01	01	H3362_025_0	8	1	Preferred Generic	3	4	001000	1	2	111		01	100		1	31	62	93				2			93				31		34	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3362	025	0	1	01	01	H3362_025_0	8	5	Specialty Tier	1	4	010010	1	1	010		01			1	31													31		34					774.81	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	025	0	1	01	01	H3362_025_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	62	93				2			93				31		34	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	025	0	1	01	01	H3362_025_0	8	2	Non-Preferred Generic	1	4	000110	1	1	111		01	100		1	31	62	93				2			93				31		34					7.27	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	025	0	1	01	01	H3362_025_0	8	3	Preferred Brand	1	4	000001	3	1	111		01	100		1	31	62	93				2			93				31		34					67.06	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	026	0	1	02	01	H3362_026_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	100		1	31	62	93				2			93				31		34	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3362	026	0	1	02	01	H3362_026_0	5	2	Non-Preferred Generic	3	4	000110	1	2	111		01	100		1	31	62	93				2			93				31		34	.19	6.00	12.00	15.00																								15.00																		6.00				.17	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3362	026	0	1	02	01	H3362_026_0	5	4	Non-Preferred Brand	1	4	100100	3	2	111		01	100		1	31	62	93				2			93				31		34	2.90	90.00	180.00	225.00																								225.00																		90.00				2.64	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	026	0	1	02	01	H3362_026_0	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	31													31		34					1023.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	026	0	1	02	01	H3362_026_0	5	3	Preferred Brand	1	4	000001	3	2	111		01	100		1	31	62	93				2			93				31		34	1.45	45.00	90.00	112.50																								112.50																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	026	0	1	02	01	H3362_026_0	5	2	Non-Preferred Generic	1	4	000110	1	2	111		01	100		1	31	62	93				2			93				31		34	.19	6.00	12.00	15.00																								15.00																		6.00				.17	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	026	0	1	02	01	H3362_026_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	62	93				2			93				31		34	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	027	0	1	01	01	H3362_027_0	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	31													31		34					1023.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	027	0	1	01	01	H3362_027_0	5	4	Non-Preferred Brand	1	4	100100	3	2	111		01	100		1	31	62	93				2			93				31		34	2.41	75.00	150.00	187.50																								187.50																		75.00				2.20	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	027	0	1	01	01	H3362_027_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	100		1	31	62	93				2			93				31		34	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3362	027	0	1	01	01	H3362_027_0	5	3	Preferred Brand	1	4	000001	3	2	111		01	100		1	31	62	93				2			93				31		34	1.45	45.00	90.00	112.50																								112.50																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	027	0	1	01	01	H3362_027_0	5	2	Non-Preferred Generic	3	4	000110	1	2	111		01	100		1	31	62	93				2			93				31		34	.22	7.00	14.00	17.50																								17.50																		7.00				.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3362	027	0	1	01	01	H3362_027_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	62	93				2			93				31		34	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	027	0	1	01	01	H3362_027_0	5	2	Non-Preferred Generic	1	4	000110	1	2	111		01	100		1	31	62	93				2			93				31		34	.22	7.00	14.00	17.50																								17.50																		7.00				.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3370	001	0	1	01	01	H3370_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.21	7.00	14.00	21.00					.06	2.00	4.00	4.00																		7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	001	0	1	01	01	H3370_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.26	9.00	18.00	27.00					.41	14.00	28.00	42.00					.26	9.00	18.00	18.00																		14.00				.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	001	0	1	01	01	H3370_001_0	5	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	001	0	1	01	01	H3370_001_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													89.00	33	33	33					89.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	001	0	1	01	01	H3370_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	001	0	1	01	01	H3370_001_0	5	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	002	0	1	01	01	H3370_002_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													69.00	33	33	33					69.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	002	0	1	01	01	H3370_002_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	002	0	1	01	01	H3370_002_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.21	7.00	14.00	21.00					.06	2.00	4.00	4.00																		7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	002	0	1	01	01	H3370_002_0	5	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	002	0	1	01	01	H3370_002_0	5	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	002	0	1	01	01	H3370_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.26	9.00	18.00	27.00					.41	14.00	28.00	42.00					.26	9.00	18.00	18.00																		14.00				.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	003	0	1	01	01	H3370_003_0	5	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	003	0	1	01	01	H3370_003_0	5	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	003	0	1	01	01	H3370_003_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	003	0	1	01	01	H3370_003_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.29	10.00	20.00	30.00					.44	15.00	30.00	45.00					.29	10.00	20.00	20.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	003	0	1	01	01	H3370_003_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.21	7.00	14.00	21.00					.06	2.00	4.00	4.00																		7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	003	0	1	01	01	H3370_003_0	5	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	004	0	1	01	01	H3370_004_0	5	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	004	0	1	01	01	H3370_004_0	5	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	004	0	1	01	01	H3370_004_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	004	0	1	01	01	H3370_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.26	9.00	18.00	27.00					.41	14.00	28.00	42.00					.26	9.00	18.00	18.00																		14.00				.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	004	0	1	01	01	H3370_004_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.21	7.00	14.00	21.00					.06	2.00	4.00	4.00																		7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	004	0	1	01	01	H3370_004_0	5	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	014	0	1	01	01	H3370_014_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.24	8.00	16.00	24.00					.38	13.00	26.00	39.00					.24	8.00	16.00	16.00																		13.00				.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	014	0	1	01	01	H3370_014_0	5	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	014	0	1	01	01	H3370_014_0	5	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	014	0	1	01	01	H3370_014_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	014	0	1	01	01	H3370_014_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.09	3.00	6.00	9.00					.24	8.00	16.00	24.00					.09	3.00	6.00	6.00																		8.00				.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3370	014	0	1	01	01	H3370_014_0	5	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															20.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					469.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	5	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	31	1.45	45.00		135.00																					1.45	45.00		112.50																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.38	12.00		36.00																					0.38	12.00		30.00																			12.00			0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	5	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	.09	3.00		9.00																					0.09	3.00		7.50																			3.00			0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	5	4	Non-Preferred Brand	1	4	100000	1	1	110		10	110		1	30		90				2	30		90					29	31					63.13	50		50																					50		42																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	5	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					1.00	30		30																					30		25																		30			30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	.09	3.00		9.00																					0.09	3.00		7.50																			3.00			0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.38	12.00		36.00																					0.38	12.00		30.00																			12.00			0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	31	1.45	45.00		135.00																					1.45	45.00		112.50																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6	4	Non-Preferred Brand	1	4	100000	1	1	110		10	110		1	30		90				2	30		90					29	31					57.00	50		50																					50		42																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					1.00	30		30																					30		25																		30			30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	056	0	1	01	01	H3384_056_0	6	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					1.00	30		30																					30		25																		30			30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	056	0	1	01	01	H3384_056_0	6	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	.06	2.00		6.00																					0.06	2.00		5.00																			2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	056	0	1	01	01	H3384_056_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.32	10.00		30.00																					0.32	10.00		25.00																			10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	056	0	1	01	01	H3384_056_0	6	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	31	1.45	45.00		135.00																					1.45	45.00		112.50																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	056	0	1	01	01	H3384_056_0	6	4	Non-Preferred Brand	1	4	100000	1	1	110		10	110		1	30		90				2	30		90					29	31					75.43	50		50																					50		42																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	6	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					1.00	30		30																					30		25																		30			30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	6	4	Non-Preferred Brand	1	4	100000	1	1	110		10	110		1	30		90				2	30		90					29	31					60.56	50		50																					50		42																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	6	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	31	1.45	45.00		135.00																					1.45	45.00		112.50																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.38	12.00		36.00																					0.38	12.00		30.00																			12.00			0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	6	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	.09	3.00		9.00																					0.09	3.00		7.50																			3.00			0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	058	0	1	02	01	H3384_058_0	6	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					1.00	30		30																					30		25																		30			30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	058	0	1	02	01	H3384_058_0	6	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	0.16	5.00		15.00																					0.16	5.00		12.50																			5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	058	0	1	02	01	H3384_058_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.48	15.00		45.00																					0.48	15.00		37.50																			15.00			0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	058	0	1	02	01	H3384_058_0	6	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	31	1.45	45.00		135.00																					1.45	45.00		112.50																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	058	0	1	02	01	H3384_058_0	6	4	Non-Preferred Brand	1	4	100000	1	1	110		10	110		1	30		90				2	30		90					29	31					57.52	50		50																					50		42																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	6	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					1.00	30		30																					30		25																		30			30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	6	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	.09	3.00		9.00																					0.09	3.00		7.50																			3.00			0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.38	12.00		36.00																					0.38	12.00		30.00																			12.00			0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	6	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	31	1.45	45.00		135.00																					1.45	45.00		112.50																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	6	4	Non-Preferred Brand	1	4	100000	1	1	110		10	110		1	30		90				2	30		90					29	31					65.85	50		50																					50		42																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.26	8.00		24.00																					0.26	8.00		16.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3388	002	0	1	01	01	H3388_002_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3388	002	0	1	01	01	H3388_002_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					848.62	30																							30																			30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.26	8.00		24.00																					0.26	8.00		16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	8	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.33	40.00		120.00																					1.33	40.00		80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.30	9.00		27.00																					0.30	9.00		18.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	6	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1029.73	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3404	001	0	1	04	01	H3404_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.20	6.00	12.00	18.00					0.83	25.00	50.00	75.00												0.20	6.00	12.00	15.00				0.83	25.00	50.00	75.00				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3404	001	0	1	04	01	H3404_001_0	7	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00												1.33	40.00	80.00	100.00				1.50	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3404	001	0	1	04	01	H3404_001_0	7	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									2.66	80.00	160.00	240.00					3.16	95.00	190.00	285.00												2.66	80.00	160.00	200.00				3.16	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3404	001	0	1	04	01	H3404_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.10	3.00	6.00	9.00					0.26	8.00	16.00	24.00												0.10	3.00	0.00	0.00				0.26	8.00	16.00	24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3404	001	0	1	04	01	H3404_001_0	7	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	2				30	60	90	30		31													1.00	33	33	33					1.00	33	33	33												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3404	002	0	1	04	01	H3404_002_0	8	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.10	3.00	6.00	9.00					0.26	8.00	16.00	24.00												0.10	3.00	0.00	0.00				0.26	8.00	16.00	24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3404	002	0	1	04	01	H3404_002_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.20	6.00	12.00	18.00					0.66	20.00	40.00	60.00												0.20	6.00	12.00	15.00				0.66	20.00	40.00	60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3404	002	0	1	04	01	H3404_002_0	8	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									2.33	70.00	140.00	210.00					3.16	95.00	190.00	285.00												2.33	70.00	140.00	175.00				3.16	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3404	002	0	1	04	01	H3404_002_0	8	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									1.00	30.00	60.00	90.00					1.50	45.00	90.00	135.00												1.00	30.00	60.00	75.00				1.50	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3404	002	0	1	04	01	H3404_002_0	8	1	Preferred Generic	3	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.10	3.00	6.00	9.00					0.26	8.00	16.00	24.00												0.10	3.00	0.00	0.00				0.26	8.00	16.00	24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3404	002	0	1	04	01	H3404_002_0	8	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	2				30	60	90	30		31													1.00	33	33	33					1.00	33	33	33												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	001	0	1	04	01	H3405_001_0	9	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	001	0	1	04	01	H3405_001_0	9	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	001	0	1	04	01	H3405_001_0	9	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	001	0	1	04	01	H3405_001_0	9	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	001	0	1	04	01	H3405_001_0	9	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	001	0	1	04	01	H3405_001_0	9	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H3405	001	0	1	04	01	H3405_001_0	9	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3405	001	0	1	04	01	H3405_001_0	9	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	001	0	1	04	01	H3405_001_0	9	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	001	0	1	04	01	H3405_001_0	9	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	002	0	1	04	01	H3405_002_0	9	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	002	0	1	04	01	H3405_002_0	9	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	002	0	1	04	01	H3405_002_0	9	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3405	002	0	1	04	01	H3405_002_0	9	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H3405	002	0	1	04	01	H3405_002_0	9	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	002	0	1	04	01	H3405_002_0	9	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	002	0	1	04	01	H3405_002_0	9	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	002	0	1	04	01	H3405_002_0	9	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	002	0	1	04	01	H3405_002_0	9	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	002	0	1	04	01	H3405_002_0	9	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	005	0	1	04	01	H3405_005_0	10	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	005	0	1	04	01	H3405_005_0	10	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	005	0	1	04	01	H3405_005_0	10	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	005	0	1	04	01	H3405_005_0	10	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	005	0	1	04	01	H3405_005_0	10	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	005	0	1	04	01	H3405_005_0	10	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H3405	005	0	1	04	01	H3405_005_0	10	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3405	005	0	1	04	01	H3405_005_0	10	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	005	0	1	04	01	H3405_005_0	10	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	005	0	1	04	01	H3405_005_0	10	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	007	0	1	04	01	H3405_007_0	10	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	007	0	1	04	01	H3405_007_0	10	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	007	0	1	04	01	H3405_007_0	10	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	007	0	1	04	01	H3405_007_0	10	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	007	0	1	04	01	H3405_007_0	10	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	007	0	1	04	01	H3405_007_0	10	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	007	0	1	04	01	H3405_007_0	10	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	007	0	1	04	01	H3405_007_0	10	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	007	0	1	04	01	H3405_007_0	10	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3405	007	0	1	04	01	H3405_007_0	10	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H3405	008	0	1	04	01	H3405_008_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	008	0	1	04	01	H3405_008_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	008	0	1	04	01	H3405_008_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	008	0	1	04	01	H3405_008_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	008	0	1	04	01	H3405_008_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	008	0	1	04	01	H3405_008_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3405	008	0	1	04	01	H3405_008_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3405	008	0	1	04	01	H3405_008_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H3405	008	0	1	04	01	H3405_008_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3405	008	0	1	04	01	H3405_008_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3421	002	0	1	09	04	H3421_002_0	5	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.13	4.00		12.00																					0.13	4.00		10.00																		4.00				0.12	4.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3421	002	0	1	09	04	H3421_002_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3421	002	0	1	09	04	H3421_002_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3421	002	0	1	09	04	H3421_002_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3447	001	0	1	01	01	H3447_001_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	8	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	001	0	1	01	01	H3447_001_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	001	0	1	01	01	H3447_001_0	8	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3447	003	0	1	01	01	H3447_003_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	8	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	003	0	1	01	01	H3447_003_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	003	0	1	01	01	H3447_003_0	8	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3447	003	0	1	01	01	H3447_003_0	8	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3447	003	0	1	01	01	H3447_003_0	8	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	004	0	1	01	01	H3447_004_0	9	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	004	0	1	01	01	H3447_004_0	9	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3447	004	0	1	01	01	H3447_004_0	9	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3447	004	0	1	01	01	H3447_004_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	004	0	1	01	01	H3447_004_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	9	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	004	0	1	01	01	H3447_004_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	9	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.32	10.00		30.00					0.32	10.00		30.00								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.90	90.00		270.00					3.06	95.00		285.00								225.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.25	8.00		24.00					0.41	13.00		39.00								20.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.29	40.00		120.00					1.45	45.00		135.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	008	0	1	01	01	H3447_008_0	7	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	008	0	1	01	01	H3447_008_0	7	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	008	0	1	01	01	H3447_008_0	7	3	Preferred Brand	1	4	000001	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.57	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	008	0	1	01	01	H3447_008_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	008	0	1	01	01	H3447_008_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	008	0	1	01	01	H3447_008_0	7	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	008	0	1	01	01	H3447_008_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	008	0	1	01	01	H3447_008_0	7	6	Select Care Drugs	1	4	010010	1	1	111		01	111		1	31	62	93				1	31	62	93				31		31					3.60	15	15	15																					15	15	15																	15				15	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3449	005	0	1	01	01	H3449_005_0	7	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									1.00	30.00	60.00	90.00					1.50	45.00	90.00	135.00												1.00	30.00	60.00	75.00				1.50	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	005	0	1	01	01	H3449_005_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.20	6.00	12.00	18.00					0.66	20.00	40.00	60.00												0.20	6.00	12.00	15.00				0.66	20.00	40.00	60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	005	0	1	01	01	H3449_005_0	7	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	2				30	60	90	30		31													1.00	33	33	33					1.00	33	33	33												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	005	0	1	01	01	H3449_005_0	7	1	Preferred Generic	3	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.10	3.00	6.00	9.00					0.26	8.00	16.00	24.00												0.10	3.00	0.00	0.00				0.26	8.00	16.00	24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3449	005	0	1	01	01	H3449_005_0	7	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.10	3.00	6.00	9.00					0.26	8.00	16.00	24.00												0.10	3.00	0.00	0.00				0.26	8.00	16.00	24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	005	0	1	01	01	H3449_005_0	7	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									2.33	70.00	140.00	210.00					3.16	95.00	190.00	285.00												2.33	70.00	140.00	175.00				3.16	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	013	0	1	01	01	H3449_013_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.20	6.00	12.00	18.00					0.83	25.00	50.00	75.00												0.20	6.00	12.00	15.00				0.83	25.00	50.00	75.00				25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	013	0	1	01	01	H3449_013_0	6	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00												1.33	40.00	80.00	100.00				1.50	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	013	0	1	01	01	H3449_013_0	6	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									2.66	80.00	160.00	240.00					3.16	95.00	190.00	285.00												2.66	80.00	160.00	200.00				3.16	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	013	0	1	01	01	H3449_013_0	6	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	2				30	60	90	30		31													1.00	33	33	33					1.00	33	33	33												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	013	0	1	01	01	H3449_013_0	6	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.10	3.00	6.00	9.00					0.26	8.00	16.00	24.00												.10	3.00	0.00	0.00				0.26	8.00	16.00	24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	001	0	1	01	01	H3456_001_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	001	0	1	01	01	H3456_001_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	001	0	1	01	01	H3456_001_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	001	0	1	01	01	H3456_001_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	001	0	1	01	01	H3456_001_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					543.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	023	0	1	01	01	H3456_023_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	023	0	1	01	01	H3456_023_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	023	0	1	01	01	H3456_023_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	023	0	1	01	01	H3456_023_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3456	023	0	1	01	01	H3456_023_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					554.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	6	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	30		30					1.00	30		30					30		30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	6	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.17	95.00		190.00					3.17	95.00		285.00					3.17	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	6	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	6	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									1.10	33.00		66.00					1.10	33.00		99.00					1.10	33.00		99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	6	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									0.00	0.00		0.00					.26	8.00		24.00					.26	8.00		24.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	6	5	Specialty Tier	1	3	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	31		31					1.00	31		31					31		31																	31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	6	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.17	95.00		190.00					3.17	95.00		285.00					3.17	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	6	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	6	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									1.10	33.00		66.00					1.10	33.00		99.00					1.10	33.00		99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	6	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									0.00	0.00		0.00					.26	8.00		24.00					.26	8.00		24.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3480	001	0	1	48	05	H3480_001_0	10	1	Generic Drugs	1	4	010000			110		01	110		1	30		90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1											
H3480	001	0	1	48	05	H3480_001_0	10	4	Non-Medicare OTC Drugs	1	4	010010			110		01	110		1	30		90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3480	001	0	1	48	05	H3480_001_0	10	3	Non-Medicare Rx Drugs	1	4	010010			110		01	110		1	30		90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3480	001	0	1	48	05	H3480_001_0	10	2	Brand Drugs	1	4	000010			110		01	110		1	30		90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1											
H3528	001	0	1	01	01	H3528_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.47	14.00	28.00	42.00					0.83	25.00	50.00	75.00					0.47	14.00	28.00	28.00																		25.00				0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	001	0	1	01	01	H3528_001_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.30	9.00	18.00	27.00					0.13	4.00	8.00	8.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	001	0	1	01	01	H3528_001_0	8	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													335.36	33	33	33					328.64	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	001	0	1	01	01	H3528_001_0	8	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.00	90.00	180.00	270.00					3.17	95.00	190.00	285.00					3.00	90.00	180.00	225.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	001	0	1	01	01	H3528_001_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	80.00	100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	7	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													335.36	33	33	33					328.64	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	7	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.47	14.00	28.00	42.00					0.63	19.00	38.00	57.00					0.47	14.00	28.00	28.00																		19.00				0.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3528	002	0	1	01	01	H3528_002_0	7	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.30	9.00	18.00	27.00					0.13	4.00	8.00	8.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3528	002	0	1	01	01	H3528_002_0	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.00	90.00	180.00	270.00					3.17	95.00	190.00	285.00					3.00	90.00	180.00	225.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	80.00	100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.47	14.00	28.00	42.00					0.63	19.00	38.00	57.00					0.47	14.00	28.00	28.00																		19.00				0.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.30	9.00	18.00	27.00					0.13	4.00	8.00	8.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.47	14.00	28.00	42.00					0.63	19.00	38.00	57.00					0.47	14.00	28.00	28.00																		19.00				0.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.00	90.00	180.00	270.00					3.17	95.00	190.00	285.00					3.00	90.00	180.00	225.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	7	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													335.36	33	33	33					328.64	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	7	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.30	9.00	18.00	27.00					0.13	4.00	8.00	8.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3528	006	0	1	02	01	H3528_006_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	80.00	100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.30	9.00	18.00	27.00					0.13	4.00	8.00	8.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	7	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.47	14.00	28.00	42.00					0.63	19.00	38.00	57.00					0.47	14.00	28.00	28.00																		19.00				0.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3528	008	0	1	02	01	H3528_008_0	7	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													335.36	33	33	33					328.64	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	008	0	1	02	01	H3528_008_0	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.00	90.00	180.00	270.00					3.17	95.00	190.00	285.00					3.00	90.00	180.00	225.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	008	0	1	02	01	H3528_008_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.47	14.00	28.00	42.00					0.83	25.00	50.00	75.00					0.47	14.00	28.00	28.00																		25.00				0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	008	0	1	02	01	H3528_008_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.30	9.00	18.00	27.00					0.13	4.00	8.00	8.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	008	0	1	02	01	H3528_008_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	80.00	100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	009	0	1	01	01	H3528_009_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.47	14.00	28.00	42.00					0.83	25.00	50.00	75.00					0.47	14.00	28.00	28.00																		25.00				0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	009	0	1	01	01	H3528_009_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.30	9.00	18.00	27.00					0.13	4.00	8.00	8.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	009	0	1	01	01	H3528_009_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	80.00	100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	009	0	1	01	01	H3528_009_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.00	90.00	180.00	270.00					3.17	95.00	190.00	285.00					3.00	90.00	180.00	225.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	009	0	1	01	01	H3528_009_0	6	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													335.36	33	33	33					328.64	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.43	13.00		39.00																												0.43	13.00		0.00				0.43	13.00		39.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.43	13.00		39.00																												0.43	13.00		0.00				0.43	13.00		39.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	005	0	1	01	01	H3533_005_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	005	0	1	01	01	H3533_005_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	005	0	1	01	01	H3533_005_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	005	0	1	01	01	H3533_005_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	005	0	1	01	01	H3533_005_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	005	0	1	01	01	H3533_005_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	005	0	1	01	01	H3533_005_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H3533	005	0	1	01	01	H3533_005_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	005	0	1	01	01	H3533_005_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	005	0	1	01	01	H3533_005_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	006	0	1	01	01	H3533_006_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H3533	006	0	1	01	01	H3533_006_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	006	0	1	01	01	H3533_006_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	006	0	1	01	01	H3533_006_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	006	0	1	01	01	H3533_006_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	006	0	1	01	01	H3533_006_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	007	0	1	01	01	H3533_007_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	007	0	1	01	01	H3533_007_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	007	0	1	01	01	H3533_007_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	007	0	1	01	01	H3533_007_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	007	0	1	01	01	H3533_007_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	007	0	1	01	01	H3533_007_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	007	0	1	01	01	H3533_007_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	007	0	1	01	01	H3533_007_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	007	0	1	01	01	H3533_007_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	007	0	1	01	01	H3533_007_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H3533	008	0	1	01	01	H3533_008_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	008	0	1	01	01	H3533_008_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	008	0	1	01	01	H3533_008_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	008	0	1	01	01	H3533_008_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.43	13.00		39.00																												0.43	13.00		0.00				0.43	13.00		39.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	008	0	1	01	01	H3533_008_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	009	0	1	01	01	H3533_009_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H3533	009	0	1	01	01	H3533_009_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	009	0	1	01	01	H3533_009_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	009	0	1	01	01	H3533_009_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	009	0	1	01	01	H3533_009_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.36	11.00		33.00																												0.36	11.00		0.00				0.36	11.00		33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	009	0	1	01	01	H3533_009_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	009	0	1	01	01	H3533_009_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.36	11.00		33.00																												0.36	11.00		0.00				0.36	11.00		33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	009	0	1	01	01	H3533_009_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	009	0	1	01	01	H3533_009_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	009	0	1	01	01	H3533_009_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	010	0	1	01	01	H3533_010_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		0.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	010	0	1	01	01	H3533_010_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H3533	010	0	1	01	01	H3533_010_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		0.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	010	0	1	01	01	H3533_010_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	010	0	1	01	01	H3533_010_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	010	0	1	01	01	H3533_010_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3536	001	0	1	01	01	H3536_001_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3536	001	0	1	01	01	H3536_001_0	7	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3536	001	0	1	01	01	H3536_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.35	80.00	160.00	240.00					2.50	85.00	170.00	255.00					2.35	80.00	240.00	240.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3536	001	0	1	01	01	H3536_001_0	7	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3536	001	0	1	01	01	H3536_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.29	10.00	20.00	30.00					.32	15.00	30.00	45.00					.29	10.00	20.00	20.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3536	001	0	1	01	01	H3536_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.12	4.00	8.00	12.00					.26	9.00	18.00	27.00					.12	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3597	001	0	1	01	01	H3597_001_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3597	001	0	1	01	01	H3597_001_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3597	001	0	1	01	01	H3597_001_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3597	001	0	1	01	01	H3597_001_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3597	001	0	1	01	01	H3597_001_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3597	002	0	1	01	01	H3597_002_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3597	002	0	1	01	01	H3597_002_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3597	002	0	1	01	01	H3597_002_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3597	002	0	1	01	01	H3597_002_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3597	002	0	1	01	01	H3597_002_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3597	002	0	1	01	01	H3597_002_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3620	004	0	1	04	01	H3620_004_0	4	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3620	004	0	1	04	01	H3620_004_0	4	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3620	004	0	1	04	01	H3620_004_0	4	2	Non-Preferred Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.96	29.00	58.00	87.00																					.96	29.00	58.00	87.00																		29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3620	004	0	1	04	01	H3620_004_0	4	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3620	004	0	1	04	01	H3620_004_0	4	5	Specialty Tier	1	3	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					960.47	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3623	001	0	1	01	01	H3623_001_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					38.58	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	001	0	1	01	01	H3623_001_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3623	001	0	1	01	01	H3623_001_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	001	0	1	01	01	H3623_001_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	001	0	1	01	01	H3623_001_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.78	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	001	0	1	01	01	H3623_001_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	003	0	1	01	01	H3623_003_0	6	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	003	0	1	01	01	H3623_003_0	6	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					74.39	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	003	0	1	01	01	H3623_003_0	6	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	003	0	1	01	01	H3623_003_0	6	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.31	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	003	0	1	01	01	H3623_003_0	6	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	003	0	1	01	01	H3623_003_0	6	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3623	004	0	1	01	01	H3623_004_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					39.17	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	004	0	1	01	01	H3623_004_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3623	004	0	1	01	01	H3623_004_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	004	0	1	01	01	H3623_004_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	004	0	1	01	01	H3623_004_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					74.70	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	004	0	1	01	01	H3623_004_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	018	0	1	01	01	H3623_018_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3623	018	0	1	01	01	H3623_018_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	018	0	1	01	01	H3623_018_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	018	0	1	01	01	H3623_018_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.86	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	018	0	1	01	01	H3623_018_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.90	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	018	0	1	01	01	H3623_018_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	019	0	1	01	01	H3623_019_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3623	019	0	1	01	01	H3623_019_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	019	0	1	01	01	H3623_019_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	019	0	1	01	01	H3623_019_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.22	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	019	0	1	01	01	H3623_019_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					34.84	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	019	0	1	01	01	H3623_019_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	020	0	1	01	01	H3623_020_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	020	0	1	01	01	H3623_020_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	020	0	1	01	01	H3623_020_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.23	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	020	0	1	01	01	H3623_020_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					34.84	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	020	0	1	01	01	H3623_020_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3623	020	0	1	01	01	H3623_020_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3653	004	0	1	01	01	H3653_004_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	2			90				30		31									.26	8.00		24.00					.43	13.00		39.00								16.00																		13.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	2			90				30		31									1.33	40.00		120.00					1.50	45.00		135.00								80.00																		45.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	8	4	Injectable Drugs	1	4	010010	1	1		010	01			1				30										30		31													52.91	33							55.70	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	8	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													873.55	33							873.55	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		6.00					.23	7.00		21.00								4.00																		7.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.33	10.00		30.00								10.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	2			90				30		31									.50	15.00		45.00					.66	20.00		60.00								30.00																		20.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	2			90				30		31									1.33	40.00		120.00					1.50	45.00		135.00								80.00																		45.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	7	4	Injectable Drugs	1	4	010010	1	4		010	01			1				30										30		31									3.16	95.00			60.25	33			3.16	95.00			63.47	33																								95.00		33		3.06	95.00	33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													746.84	33							746.84	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3655	013	0	1	01	01	H3655_013_0	6	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3655	013	0	1	01	01	H3655_013_0	6	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													80.00	33	33	33					80.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3655	013	0	1	01	01	H3655_013_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3655	013	0	1	01	01	H3655_013_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.09	3.00	6.00	9.00					0.24	8.00	16.00	24.00					0.09	3.00	6.00	6.00																		8.00				0.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3655	013	0	1	01	01	H3655_013_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.26	9.00	18.00	27.00					.41	14.00	28.00	42.00					.26	9.00	18.00	18.00																		14.00				0.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3655	013	0	1	01	01	H3655_013_0	6	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3655	030	0	1	01	01	H3655_030_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3655	030	0	1	01	01	H3655_030_0	5	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3655	030	0	1	01	01	H3655_030_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.18	6.00	12.00	18.00					0.32	11.00	22.00	33.00					0.18	6.00	12.00	12.00																		11.00				0.32	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3655	030	0	1	01	01	H3655_030_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.09	3.00	6.00	9.00					0.24	8.00	16.00	24.00					0.09	3.00	6.00	6.00																		8.00				0.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3655	030	0	1	01	01	H3655_030_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													87.00	33	33	33					87.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3655	030	0	1	01	01	H3655_030_0	5	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3659	001	0	1	01	01	H3659_001_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					575.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	001	0	1	01	01	H3659_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	001	0	1	01	01	H3659_001_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	001	0	1	01	01	H3659_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.23	7.00		21.00																															14.00							21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	001	0	1	01	01	H3659_001_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	003	0	1	01	01	H3659_003_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3659	003	0	1	01	01	H3659_003_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					616.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	003	0	1	01	01	H3659_003_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	003	0	1	01	01	H3659_003_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	003	0	1	01	01	H3659_003_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	003	0	1	01	01	H3659_003_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	031	0	1	01	01	H3659_031_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	031	0	1	01	01	H3659_031_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	031	0	1	01	01	H3659_031_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	031	0	1	01	01	H3659_031_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					585.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3659	031	0	1	01	01	H3659_031_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	028	0	1	02	01	H3660_028_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.50	15.00		45.00																								37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	028	0	1	02	01	H3660_028_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	028	0	1	02	01	H3660_028_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	028	0	1	02	01	H3660_028_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	028	0	1	02	01	H3660_028_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					618.08	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	029	0	1	02	01	H3660_029_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.50	15.00		45.00																								37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	029	0	1	02	01	H3660_029_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	029	0	1	02	01	H3660_029_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	029	0	1	02	01	H3660_029_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					618.08	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	029	0	1	02	01	H3660_029_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	044	0	1	01	01	H3660_044_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	044	0	1	01	01	H3660_044_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.50	15.00		45.00																								37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	044	0	1	01	01	H3660_044_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	044	0	1	01	01	H3660_044_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	044	0	1	01	01	H3660_044_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					334.47	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	047	0	1	01	01	H3660_047_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	047	0	1	01	01	H3660_047_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.50	15.00		45.00																								37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	047	0	1	01	01	H3660_047_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	047	0	1	01	01	H3660_047_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	047	0	1	01	01	H3660_047_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					334.47	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	048	0	1	02	01	H3660_048_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					618.08	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	048	0	1	02	01	H3660_048_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.50	15.00		45.00																								37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	048	0	1	02	01	H3660_048_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	048	0	1	02	01	H3660_048_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3660	048	0	1	02	01	H3660_048_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.33	10.00	20.00	30.00																					.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1342.60	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4	5	Specialty Tier	1	3	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1368.25	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4	2	Non-Preferred Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.10	33.00	66.00	99.00																					1.10	33.00	66.00	99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	4	2	Non-Preferred Generic	3	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	10.00	20.00	30.00																					0.03	10.00	20.00	20.00																		10.00				0.03	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	005	0	1	01	01	H3668_005_0	4	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	4	2	Non-Preferred Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	10.00	20.00	30.00																					0.03	10.00	20.00	20.00																		10.00				0.03	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.27	38.00	76.00	114.00																					1.27	38.00	76.00	76.00																		38.00				1.23	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	4	1	Preferred Generic	3	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	005	0	1	01	01	H3668_005_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					660.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.67	50.00	100.00	150.00																					1.67	50.00	100.00	100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_0	5	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_0	5	1	Preferred Generic	3	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.06	2.00	4.00	6.00																					0.06	2.00	0.00	0.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	011	0	1	01	01	H3668_011_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					660.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_0	5	2	Non-Preferred Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00	24.00	24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_0	5	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.06	2.00	4.00	6.00																					0.06	2.00	0.00	0.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	4	2	Non-Preferred Generic	3	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	10.00	20.00	30.00																					0.03	10.00	20.00	20.00																		10.00				0.03	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	014	0	1	01	01	H3668_014_0	4	1	Preferred Generic	3	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	014	0	1	01	01	H3668_014_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					660.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.67	50.00	100.00	150.00																					1.67	50.00	100.00	100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.27	38.00	76.00	114.00																					1.27	38.00	76.00	76.00																		38.00				1.23	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	4	2	Non-Preferred Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	10.00	20.00	30.00																					0.03	10.00	20.00	20.00																		10.00				0.03	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	4	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	6	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.06	2.00	4.00	6.00																					0.06	2.00	0.00	0.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					660.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	6	1	Preferred Generic	3	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.06	2.00	4.00	6.00																					0.06	2.00	0.00	0.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	015	0	1	01	01	H3668_015_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	6	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	6	2	Non-Preferred Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00	24.00	24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	4	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	4	2	Non-Preferred Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	10.00	20.00	30.00																					0.03	10.00	20.00	20.00																		10.00				0.03	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.67	50.00	100.00	150.00																					1.67	50.00	100.00	100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					660.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	4	1	Preferred Generic	3	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	016	0	1	01	01	H3668_016_0	4	2	Non-Preferred Generic	3	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	10.00	20.00	30.00																					0.03	10.00	20.00	20.00																		10.00				0.03	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	016	0	1	01	01	H3668_016_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.27	38.00	76.00	114.00																					1.27	38.00	76.00	76.00																		38.00				1.23	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	6	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.06	2.00	4.00	6.00																					0.06	2.00	0.00	0.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	6	2	Non-Preferred Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00	24.00	24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	6	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					660.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	6	1	Preferred Generic	3	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.06	2.00	4.00	6.00																					0.06	2.00	0.00	0.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3672	013	0	1	01	01	H3672_013_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.27	8.00		24.00																								16.00																		8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.50	15.00		45.00																								30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1000.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.27	8.00		24.00																								16.00																		8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H3672	013	0	1	01	01	H3672_013_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.50	15.00		45.00																								30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H3672	016	0	1	01	01	H3672_016_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3672	016	0	1	01	01	H3672_016_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3672	016	0	1	01	01	H3672_016_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3672	016	0	1	01	01	H3672_016_0	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3672	016	0	1	01	01	H3672_016_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H3672	016	0	1	01	01	H3672_016_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H3672	018	0	1	01	01	H3672_018_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.67	20.00		60.00																								40.00																		20.00				0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	12	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	12	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	12	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H3706	001	0	1	01	01	H3706_001_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	7	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3712	001	0	1	01	01	H3712_001_0	11	5	Specialty Tier	1	4	010010	3	1	010		01			1	30													30		31					187.81	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3712	001	0	1	01	01	H3712_001_0	11	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	20.00		60.00																								60.00																		20.00				0.00	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3712	001	0	1	01	01	H3712_001_0	11	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3712	001	0	1	01	01	H3712_001_0	11	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3712	001	0	1	01	01	H3712_001_0	11	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3712	001	0	1	01	01	H3712_001_0	11	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3712	001	0	1	01	01	H3712_001_0	11	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3712	001	0	1	01	01	H3712_001_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3712	001	0	1	01	01	H3712_001_0	11	4	Non-Preferred Brand	3	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	.58	20.00		60.00																								60.00																		20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3712	002	0	1	01	01	H3712_002_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3712	002	0	1	01	01	H3712_002_0	10	5	Specialty Tier	1	4	010010	3	1	010		01			1	30													30		31					196.41	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3712	002	0	1	01	01	H3712_002_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	45.00		135.00																								135.00																		45.00				0.00	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3712	002	0	1	01	01	H3712_002_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.00	25.00		75.00																								75.00																		25.00				0.00	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3712	002	0	1	01	01	H3712_002_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3712	002	0	1	01	01	H3712_002_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.23	7.00		21.00																															14.00							21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					584.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	004	0	1	01	01	H3749_004_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					486.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	004	0	1	01	01	H3749_004_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	004	0	1	01	01	H3749_004_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	004	0	1	01	01	H3749_004_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	004	0	1	01	01	H3749_004_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					607.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	5	6	Injectable Drugs	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					63.82	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	001	0	1	01	01	H3755_001_0	5	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					63.82	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	001	0	1	01	01	H3755_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.17	95.00		285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	001	0	1	01	01	H3755_001_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.33	40.00		120.00																								120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	001	0	1	01	01	H3755_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	001	0	1	01	01	H3755_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.40	12.00		36.00																								36.00																		12.00				0.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	004	0	1	01	01	H3755_004_0	7	6	Injectable Drugs	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					75.12	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	004	0	1	01	01	H3755_004_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	004	0	1	01	01	H3755_004_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.40	12.00		36.00																								36.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	004	0	1	01	01	H3755_004_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.33	40.00		120.00																								120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	004	0	1	01	01	H3755_004_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.17	95.00		285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	004	0	1	01	01	H3755_004_0	7	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					75.12	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	005	0	1	01	01	H3755_005_0	4	6	Injectable Drugs	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					63.82	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	005	0	1	01	01	H3755_005_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.17	5.00		15.00																								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	005	0	1	01	01	H3755_005_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.43	13.00		39.00																								39.00																		13.00				0.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	005	0	1	01	01	H3755_005_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.33	40.00		120.00																								120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	005	0	1	01	01	H3755_005_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.00	90.00		270.00																								270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	005	0	1	01	01	H3755_005_0	4	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31					63.82	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3805	001	0	1	01	01	H3805_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.46	44.00		132.00																															122.00							132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.20	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					395.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.46	44.00		132.00																															122.00							132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.23	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					498.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_0	5	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.23	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_0	5	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_0	5	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					398.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	013	0	1	01	01	H3805_013_0	5	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	013	0	1	01	01	H3805_013_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	013	0	1	01	01	H3805_013_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	013	0	1	01	01	H3805_013_0	5	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	013	0	1	01	01	H3805_013_0	5	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					512.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	12	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	.16	5.00	10.00	0.00																												.16	5.00	10.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	12	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	.33	10.00	20.00	20.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3810	003	0	1	01	01	H3810_003_0	12	5	Specialty Tier	1	4	100000	1	1	111		01		111	1	30	60	90				1				30	60	90	30		31						33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	12	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	3.16	95.00	190.00	190.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	12	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	1.50	45.00	90.00	90.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	12	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	.50	15.00	30.00	30.00																												.50	15.00	30.00	30.00				.50	15.00	30.00	45.00				15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	007	0	1	01	01	H3810_007_0	13	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	.50	15.00	30.00	30.00																												.50	15.00	30.00	30.00				.50	15.00	30.00	45.00				15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	007	0	1	01	01	H3810_007_0	13	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	.16	5.00	10.00	0.00																												.16	5.00	10.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	007	0	1	01	01	H3810_007_0	13	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	1.50	45.00	90.00	90.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	007	0	1	01	01	H3810_007_0	13	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	3.16	95.00	190.00	190.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	007	0	1	01	01	H3810_007_0	13	5	Specialty Tier	1	4	100000	1	1	111		01		111	1	30	60	90				1				30	60	90	30		31						33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	007	0	1	01	01	H3810_007_0	13	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	.33	10.00	20.00	20.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3811	002	0	1	01	01	H3811_002_0	6	5	Specialty Tier	1	4	000001	1	1	010		01			1	34													34		31					68.51	30																																										30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	34	60	90				2			90				34		31	2.35	80.00	160.00	240.00																								240.00																		80.00				0.00	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	34	60	90				2			90				34		31	1.17	40.00	80.00	120.00																								120.00																		40.00				0.00	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	34	60	90				2			90				34		31	0.26	9.00	18.00	27.00																								27.00																		9.00				0.00	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	34	60	90				1			90				34		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	6	5	Specialty Tier	1	4	000010	1	1	010		01			1	34													34		31					68.51	30																																										30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	100		1	34	60	90				1			90				34		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3811	009	0	1	01	01	H3811_009_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	34	60	90				1			90				34		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	34	60	90				2			90				34		31	0.26	9.00	18.00	27.00																								27.00																		9.00				0.00	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	34	60	90				2			90				34		31	2.35	80.00	160.00	240.00																								240.00																		80.00				0.00	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	34	60	90				2			90				34		31	1.17	40.00	80.00	120.00																								120.00																		40.00				0.00	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	6	2	Non-Preferred Generic	3	4	000100	1	2	111		01	100		1	34	60	90				2			90				34		31	0.00	9.00	18.00	27.00																								27.00																		9.00				0.00	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3812	001	0	1	04	01	H3812_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					566.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3812	001	0	1	04	01	H3812_001_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3812	001	0	1	04	01	H3812_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3812	001	0	1	04	01	H3812_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.23	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3812	001	0	1	04	01	H3812_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	004	0	1	04	01	H3813_004_0	4	5	Specialty Tier	1	4	100100	1	1	010		01	010		1	31							31						31		31					300.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	004	0	1	04	01	H3813_004_0	4	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				1	31	62	93				31		31					75.00	50	50	50																					50	50	50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	004	0	1	04	01	H3813_004_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	004	0	1	04	01	H3813_004_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	1.06	33.00	66.00	99.00																					1.06	33.00	66.00	99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	004	0	1	04	01	H3813_004_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	.16	5.00	10.00	15.00																					.16	5.00	10.00	15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	005	0	1	04	01	H3813_005_0	4	5	Specialty Tier	1	4	100100	1	1	010		01	010		1	31							31						31		31					300.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	005	0	1	04	01	H3813_005_0	4	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				1	31	62	93				31		31					75.00	50	50	50																					50	50	50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	005	0	1	04	01	H3813_005_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	005	0	1	04	01	H3813_005_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	1.06	33.00	66.00	99.00																					1.06	33.00	66.00	99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	005	0	1	04	01	H3813_005_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	.16	5.00	10.00	15.00																					.16	5.00	10.00	15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	1.06	33.00	66.00	99.00																					1.06	33.00	66.00	99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	3	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				1	31	62	93				31		31					75.00	50	50	50																					50	50	50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	3	5	Specialty Tier	1	4	100000	1	1	010		01	010		1	31							31						31		31					300.00	30																							30																			30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	1.32	41.00	82.00	123.00																					1.32	41.00	82.00	123.00																		41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	.16	5.00	10.00	15.00																					.16	5.00	10.00	15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	11	4	Injectable Drugs	1	4	010010	1	1	111		10	100		1	30	60	90				1			90					20	31					100.00	33	33	33																							33																		33			33	Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	11	5	Specialty Tier	1	4	010010	1	1	010		10			1	30														20	31					100.00	33																																											33			33	Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	11	3	Non-Preferred Brand	1	4	100000	3	2	111		10	100		1	30	60	90				1			90					20	31	2.50	75.00	150.00	225.00																								150.00																			75.00			2.42	75.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	11	1	Generic	1	4	010000	1	2	111		10	100		1	30	60	90				1			90					20	31	.17	5.00	10.00	15.00																								10.00																			5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	11	2	Preferred Brand	1	4	000001	1	2	111		10	100		1	30	60	90				1			90					20	31	1.00	30.00	60.00	90.00																								60.00																			30.00			.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	11	1	Generic	1	4	010000	1	2	111		10	100		1	30	60	90				1			90					20	31	.17	5.00	10.00	15.00																								10.00																			5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	11	2	Preferred Brand	1	4	000001	1	2	111		10	100		1	30	60	90				1			90					20	31	1.00	30.00	60.00	90.00																								60.00																			30.00			.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	11	3	Non-Preferred Brand	1	4	100000	3	2	111		10	100		1	30	60	90				1			90					20	31	2.50	75.00	150.00	225.00																								150.00																			75.00			2.42	75.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	11	4	Injectable Drugs	1	4	010010	1	1	111		10	100		1	30	60	90				1			90					20	31					100.00	33	33	33																							33																		33			33	Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	11	5	Specialty Tier	1	4	010010	1	1	010		10			1	30														20	31					100.00	33																																											33			33	Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	11	2	Preferred Brand	1	4	000001	1	2	111		10	100		1	30	60	90				1			90					20	31	1.00	30.00	60.00	90.00																								60.00																			30.00			.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	11	3	Non-Preferred Brand	1	4	100000	3	2	111		10	100		1	30	60	90				1			90					20	31	2.50	75.00	150.00	225.00																								150.00																			75.00			1.93	75.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	11	4	Injectable Drugs	1	4	010010	1	1	111		10	100		1	30	60	90				1			90					20	31					100.00	33	33	33																							33																		33			33	Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	11	5	Specialty Tier	1	4	010010	1	1	010		10			1	30														20	31					100.00	33																																											33			33	Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	11	1	Generic	1	4	010000	1	2	111		10	100		1	30	60	90				1			90					20	31	.17	5.00	10.00	15.00																								10.00																			5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3817	002	0	1	04	01	H3817_002_0	15	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	002	0	1	04	01	H3817_002_0	15	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					408.00	27																							27																			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	002	0	1	04	01	H3817_002_0	15	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	002	0	1	04	01	H3817_002_0	15	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.23	7.00		21.00																					0.23	7.00		14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	002	0	1	04	01	H3817_002_0	15	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	003	0	1	04	01	H3817_003_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	003	0	1	04	01	H3817_003_0	11	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	003	0	1	04	01	H3817_003_0	11	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	003	0	1	04	01	H3817_003_0	11	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	003	0	1	04	01	H3817_003_0	11	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					604.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	003	0	1	04	01	H3817_003_0	11	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3818	003	0	1	01	01	H3818_003_0	18	1	Preferred Generic	1	3	001001	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	18	2	Non-Preferred Generic	1	3	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	.23	7.00	14.00	21.00																					.23	7.00	14.00	14.00																			7.00			.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	18	3	Preferred Brand	1	3	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	1.00	30.00	60.00	90.00																					1.00	30.00	60.00	60.00																			30.00			.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	18	4	Non-Preferred Brand	1	3	100100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	2.33	70.00	140.00	210.00																					2.33	70.00	140.00	140.00																			70.00			2.26	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	18	5	Specialty Tier	1	3	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					10	31					700.00	27	27	27																					27	27	27																		27			27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	014	0	1	01	01	H3818_014_0	18	1	Preferred Generic	1	4	001001	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	014	0	1	01	01	H3818_014_0	18	2	Non-Preferred Generic	1	4	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	.22	7.00	14.00	21.00																					.22	7.00	14.00	14.00																			7.00			.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	014	0	1	01	01	H3818_014_0	18	3	Preferred Brand	1	4	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	.99	30.00	60.00	90.00																					.99	30.00	60.00	60.00																			30.00			.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	014	0	1	01	01	H3818_014_0	18	4	Non-Preferred Brand	1	4	100100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	2.33	70.00	140.00	210.00																					2.33	70.00	140.00	140.00																			70.00			2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	014	0	1	01	01	H3818_014_0	18	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					10	31					700.00	30	30	30																					30	30	30																		30			30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	14	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	14	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	14	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	14	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	14	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	12	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	12	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	12	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		87.50					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	11	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	11	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		87.50					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	11	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	11	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	004	0	1	01	01	H3822_004_0	13	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	004	0	1	01	01	H3822_004_0	13	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	004	0	1	01	01	H3822_004_0	13	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		87.50					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	004	0	1	01	01	H3822_004_0	13	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	004	0	1	01	01	H3822_004_0	13	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	005	0	1	02	01	H3822_005_0	12	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	005	0	1	02	01	H3822_005_0	12	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		87.50					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	005	0	1	02	01	H3822_005_0	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	005	0	1	02	01	H3822_005_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	005	0	1	02	01	H3822_005_0	12	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	14	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	14	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	14	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	14	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	14	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	16	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	16	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	16	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	16	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	16	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	001	0	1	04	01	H3832_001_0	9	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		34	0.20	6.00		18.00																								6.00																		6.00				0.17	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	001	0	1	04	01	H3832_001_0	9	1	Generic	3	4	010000	1	2	110		01	100		1	30		90				2			90				30		34	0.20	6.00		18.00																								6.00																		6.00				0.17	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3832	001	0	1	04	01	H3832_001_0	9	4	Specialty Tier	1	4	010010	1	1	110		01			1	30		90				2							30		34					359.68	33		33																																								33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	001	0	1	04	01	H3832_001_0	9	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	3.16	95.00		285.00																								190.00																		95.00				2.79	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	001	0	1	04	01	H3832_001_0	9	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	1.50	45.00		135.00																								90.00																		45.00				1.32	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	006	0	1	04	01	H3832_006_0	11	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		34	0.16	5.00		15.00																								5.00																		5.00				0.14	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	006	0	1	04	01	H3832_006_0	11	1	Generic	3	4	010000	1	2	110		01	100		1	30		90				2			90				30		34	0.16	5.00		15.00																								5.00																		5.00				0.14	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3832	006	0	1	04	01	H3832_006_0	11	4	Specialty Tier	1	4	010001	1	1	110		01			1	30		90				2							30		34					431.90	33		33																																								33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	006	0	1	04	01	H3832_006_0	11	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	2.50	75.00		225.00																								150.00																		75.00				2.20	75.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	006	0	1	04	01	H3832_006_0	11	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	1.33	40.00		120.00																								80.00																		40.00				1.17	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	006	0	1	01	01	H3864_006_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	006	0	1	01	01	H3864_006_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		93				2	31		93				31		31	0.32	10.00		30.00																					0.32	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	006	0	1	01	01	H3864_006_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		93				2	31		93				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	006	0	1	01	01	H3864_006_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		93				2	31		93				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	006	0	1	01	01	H3864_006_0	9	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	31							31						31		31					903.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	006	0	1	01	01	H3864_006_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3864	014	0	1	01	01	H3864_014_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		93				2	31		93				31		31	0.32	10.00		30.00																					0.32	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	014	0	1	01	01	H3864_014_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	014	0	1	01	01	H3864_014_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		93				2	31		93				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	014	0	1	01	01	H3864_014_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3864	014	0	1	01	01	H3864_014_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	31							31						31		31					903.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	014	0	1	01	01	H3864_014_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		93				2	31		93				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	015	0	1	01	01	H3864_015_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	015	0	1	01	01	H3864_015_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		93				2	31		93				31		31	0.32	10.00		30.00																					0.32	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	015	0	1	01	01	H3864_015_0	8	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	31							31						31		31					903.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	015	0	1	01	01	H3864_015_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		93				2	31		93				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	015	0	1	01	01	H3864_015_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		93				2	31		93				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	015	0	1	01	01	H3864_015_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3864	016	0	1	01	01	H3864_016_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		93				2	31		93				31		31	0.32	10.00		30.00																					0.32	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	016	0	1	01	01	H3864_016_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	016	0	1	01	01	H3864_016_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		93				2	31		93				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	016	0	1	01	01	H3864_016_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3864	016	0	1	01	01	H3864_016_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	31							31						31		31					903.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	016	0	1	01	01	H3864_016_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		93				2	31		93				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	019	0	1	01	01	H3864_019_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		93				2	31		93				31		31	0.32	10.00		30.00																					0.32	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	019	0	1	01	01	H3864_019_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	019	0	1	01	01	H3864_019_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		93				2	31		93				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	019	0	1	01	01	H3864_019_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		93				2	31		93				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	019	0	1	01	01	H3864_019_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	31							31						31		31					903.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	019	0	1	01	01	H3864_019_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3864	020	0	1	01	01	H3864_020_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		93				2	31		93				31		31	0.32	10.00		30.00																					0.32	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	020	0	1	01	01	H3864_020_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	020	0	1	01	01	H3864_020_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		93				2	31		93				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	020	0	1	01	01	H3864_020_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3864	020	0	1	01	01	H3864_020_0	8	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	31							31						31		31					903.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	020	0	1	01	01	H3864_020_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		93				2	31		93				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	021	0	1	01	01	H3864_021_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	021	0	1	01	01	H3864_021_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		93				2	31		93				31		31	0.32	10.00		30.00																					0.32	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	021	0	1	01	01	H3864_021_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		93				2	31		93				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	021	0	1	01	01	H3864_021_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		93				2	31		93				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	021	0	1	01	01	H3864_021_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	31							31						31		31					903.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	021	0	1	01	01	H3864_021_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3887	003	0	1	02	01	H3887_003_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3887	003	0	1	02	01	H3887_003_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3887	003	0	1	02	01	H3887_003_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					592.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3887	003	0	1	02	01	H3887_003_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3887	003	0	1	02	01	H3887_003_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3907	006	0	1	01	01	H3907_006_0	8	3	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	006	0	1	01	01	H3907_006_0	8	2	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	006	0	1	01	01	H3907_006_0	8	1	Generic	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	.25	8.00		24.00																								16.00																		8.00				.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	006	0	1	01	01	H3907_006_0	8	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	31							31						31		31					760.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	006	0	1	01	01	H3907_006_0	8	5	Select Care Drugs	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	10	1	Generic	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	.25	8.00		24.00																								16.00																		8.00				.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	10	2	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	10	3	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	10	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	31							31						31		31					760.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	10	5	Select Care Drugs	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	9	3	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	9	2	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	9	1	Generic	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	9	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	31							31						31		31					760.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	9	5	Select Care Drugs	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	7	1	Generic	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	7	2	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	7	3	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	7	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	31							31						31		31					760.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	7	5	Select Care Drugs	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3909	001	0	1	04	01	H3909_001_0	8	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								10.00																		5.00				0.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.33	40.00		120.00																								80.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	8	4	Specialty Tier	1	4	110001	1	1	110		01	100		1	30		90				1			90				30		31					365.68	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		240.00																								160.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	9	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								10.00																		5.00				0.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	9	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		240.00																								160.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	9	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.33	40.00		120.00																								80.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	9	4	Specialty Tier	1	4	110001	1	1	110		01	100		1	30		90				1			90				30		31					365.68	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	5	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.25	8.00		24.00																								20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	5	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.35	42.00		126.00																								105.00																		42.00				1.35	42.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	5	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	5	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					907.94	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	5	1	Generic	3	4	010000	1	1	110		01	100		1	31		90				1			90				31		31					17.15	50		50																							50																	50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	002	0	1	04	01	H3916_002_0	5	1	Generic	3	4	010000	1	1	110		01	100		1	31		90				1			90				31		31					15.34	50		50																							50																	50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	002	0	1	04	01	H3916_002_0	5	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					949.01	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	5	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	5	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.35	42.00		126.00																								105.00																		42.00				1.35	42.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	5	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.25	8.00		24.00																								20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	5	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	5	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.35	42.00		126.00																								105.00																		42.00				1.35	42.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	5	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.25	8.00		24.00																								20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	5	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1156.58	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	5	1	Generic	3	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.25	8.00		24.00																								20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	015	0	1	04	01	H3916_015_0	5	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1293.56	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	5	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	5	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	5	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.25	8.00		24.00																								20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	5	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	5	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	5	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.32	10.00		30.00																								25.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	5	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1229.83	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	019	0	1	04	01	H3916_019_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1147.47	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	019	0	1	04	01	H3916_019_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	019	0	1	04	01	H3916_019_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	019	0	1	04	01	H3916_019_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	019	0	1	04	01	H3916_019_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.64	20.00		60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	020	0	1	04	01	H3916_020_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	020	0	1	04	01	H3916_020_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.64	20.00		60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	020	0	1	04	01	H3916_020_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	020	0	1	04	01	H3916_020_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	020	0	1	04	01	H3916_020_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1102.91	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	5	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					959.25	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	5	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	5	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	5	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.29	9.00		27.00																								22.50																		9.00				0.29	9.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	5	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	5	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	5	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.29	9.00		27.00																								22.50																		9.00				0.29	9.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	5	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1154.49	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	025	0	1	04	01	H3916_025_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1054.16	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	025	0	1	04	01	H3916_025_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	025	0	1	04	01	H3916_025_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	025	0	1	04	01	H3916_025_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	025	0	1	04	01	H3916_025_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.64	20.00		60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.48	15.00		45.00																								37.50																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					947.77	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1130.74	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.48	15.00		45.00																								37.50																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	001	0	1	04	01	H3921_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					539.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	001	0	1	04	01	H3921_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	001	0	1	04	01	H3921_001_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	001	0	1	04	01	H3921_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	001	0	1	04	01	H3921_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	008	0	1	04	01	H3921_008_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					468.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	008	0	1	04	01	H3921_008_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	008	0	1	04	01	H3921_008_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	008	0	1	04	01	H3921_008_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	008	0	1	04	01	H3921_008_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	009	0	1	04	01	H3921_009_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	009	0	1	04	01	H3921_009_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	009	0	1	04	01	H3921_009_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	009	0	1	04	01	H3921_009_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					468.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3921	009	0	1	04	01	H3921_009_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.55	17.00		51.00					.71	22.00		66.00					.55	17.00		51.00																		22.00				.71	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.23	38.00		114.00					1.45	45.00		135.00					1.23	38.00		114.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.90	90.00		270.00					3.06	95.00		285.00					2.90	90.00		270.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													579.00	33							579.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.16	5.00		15.00					.32	10.00		30.00					.16	5.00		15.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.87	89.00		267.00					3.06	95.00		285.00					2.87	89.00		267.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													681.00	33							681.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.23	38.00		114.00					1.45	45.00		135.00					1.23	38.00		114.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.32	10.00		30.00					.48	15.00		45.00					.32	10.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.13	4.00		12.00					.29	9.00		27.00					.13	4.00		12.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	003	0	1	04	01	H3924_003_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	003	0	1	04	01	H3924_003_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	003	0	1	04	01	H3924_003_0	5	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	003	0	1	04	01	H3924_003_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	003	0	1	04	01	H3924_003_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	003	0	1	04	01	H3924_003_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	023	0	1	04	01	H3924_023_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	023	0	1	04	01	H3924_023_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	023	0	1	04	01	H3924_023_0	4	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	023	0	1	04	01	H3924_023_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	023	0	1	04	01	H3924_023_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	023	0	1	04	01	H3924_023_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	046	0	1	04	01	H3924_046_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	046	0	1	04	01	H3924_046_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	046	0	1	04	01	H3924_046_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	046	0	1	04	01	H3924_046_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	046	0	1	04	01	H3924_046_0	5	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	046	0	1	04	01	H3924_046_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	048	0	1	04	01	H3924_048_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	048	0	1	04	01	H3924_048_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	048	0	1	04	01	H3924_048_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	048	0	1	04	01	H3924_048_0	4	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	048	0	1	04	01	H3924_048_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	048	0	1	04	01	H3924_048_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	052	0	1	04	01	H3924_052_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	052	0	1	04	01	H3924_052_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	052	0	1	04	01	H3924_052_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	052	0	1	04	01	H3924_052_0	4	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	052	0	1	04	01	H3924_052_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	052	0	1	04	01	H3924_052_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	054	0	1	04	01	H3924_054_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	054	0	1	04	01	H3924_054_0	4	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	054	0	1	04	01	H3924_054_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	054	0	1	04	01	H3924_054_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	054	0	1	04	01	H3924_054_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	054	0	1	04	01	H3924_054_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	9	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.83	55.00	110.00	110.00																					1.83	55.00	110.00	110.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.16	35.00	70.00	70.00																					1.16	35.00	70.00	70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	3.00	3.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	9	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					.10	3.00	3.00	3.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3928	001	0	1	01	01	H3928_001_0	9	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	9	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3931	004	0	1	01	01	H3931_004_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	004	0	1	01	01	H3931_004_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	004	0	1	01	01	H3931_004_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	004	0	1	01	01	H3931_004_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	004	0	1	01	01	H3931_004_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	004	0	1	01	01	H3931_004_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3931	058	0	1	01	01	H3931_058_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3931	058	0	1	01	01	H3931_058_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	058	0	1	01	01	H3931_058_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	058	0	1	01	01	H3931_058_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	058	0	1	01	01	H3931_058_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	058	0	1	01	01	H3931_058_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	064	0	1	01	01	H3931_064_0	6	5	Select Care Drugs	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	064	0	1	01	01	H3931_064_0	6	4	Specialty Tier	1	3	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	064	0	1	01	01	H3931_064_0	6	3	Non-Preferred Brand	1	3	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	064	0	1	01	01	H3931_064_0	6	2	Preferred Brand	1	3	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.43	43.00	86.00	129.00																												1.43	43.00	86.00	86.00				1.43	43.00	86.00	129.00					43.00			1.38	43.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	064	0	1	01	01	H3931_064_0	6	1	Generic	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	065	0	1	01	01	H3931_065_0	7	5	Select Care Drugs	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	065	0	1	01	01	H3931_065_0	7	4	Specialty Tier	1	3	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	065	0	1	01	01	H3931_065_0	7	1	Generic	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	065	0	1	01	01	H3931_065_0	7	2	Preferred Brand	1	3	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.36	41.00	82.00	123.00																												1.36	41.00	82.00	82.00				1.36	41.00	82.00	123.00					41.00			1.32	41.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	065	0	1	01	01	H3931_065_0	7	3	Non-Preferred Brand	1	3	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	070	0	1	01	01	H3931_070_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	070	0	1	01	01	H3931_070_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	070	0	1	01	01	H3931_070_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	070	0	1	01	01	H3931_070_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	070	0	1	01	01	H3931_070_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	070	0	1	01	01	H3931_070_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3931	081	0	1	01	01	H3931_081_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3931	081	0	1	01	01	H3931_081_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	081	0	1	01	01	H3931_081_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	081	0	1	01	01	H3931_081_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	081	0	1	01	01	H3931_081_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	081	0	1	01	01	H3931_081_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	082	0	1	01	01	H3931_082_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	082	0	1	01	01	H3931_082_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	082	0	1	01	01	H3931_082_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	082	0	1	01	01	H3931_082_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	082	0	1	01	01	H3931_082_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3931	082	0	1	01	01	H3931_082_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	083	0	1	01	01	H3931_083_0	6	5	Select Care Drugs	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	083	0	1	01	01	H3931_083_0	6	4	Specialty Tier	1	3	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	083	0	1	01	01	H3931_083_0	6	3	Non-Preferred Brand	1	3	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	083	0	1	01	01	H3931_083_0	6	1	Generic	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	083	0	1	01	01	H3931_083_0	6	2	Preferred Brand	1	3	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.40	42.00	84.00	126.00																												1.40	42.00	84.00	84.00				1.40	42.00	84.00	126.00					42.00			1.35	42.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	084	0	1	01	01	H3931_084_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	084	0	1	01	01	H3931_084_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	084	0	1	01	01	H3931_084_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	084	0	1	01	01	H3931_084_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	084	0	1	01	01	H3931_084_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3931	084	0	1	01	01	H3931_084_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3945	003	0	1	02	01	H3945_003_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.50	75.00	150.00	225.00																					2.50	75.00		215.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					499.12	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00		6.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00		6.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	006	0	1	01	01	H3945_006_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3945	006	0	1	01	01	H3945_006_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					484.67	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	006	0	1	01	01	H3945_006_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	006	0	1	01	01	H3945_006_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	006	0	1	01	01	H3945_006_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	006	0	1	01	01	H3945_006_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3945	006	0	1	01	01	H3945_006_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	002	0	1	01	01	H3949_002_0	2	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	002	0	1	01	01	H3949_002_0	2	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.33	40.00	80.00	120.00																					1.33	40.00		110.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	002	0	1	01	01	H3949_002_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.33	10.00	20.00	30.00																					0.33	10.00		21.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	002	0	1	01	01	H3949_002_0	2	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.13	4.00	8.00	12.00																					0.13	4.00		3.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	002	0	1	01	01	H3949_002_0	2	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					580.04	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.26	8.00	16.00	24.00																					0.26	8.00		15.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	2	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.13	4.00	8.00	12.00																					0.13	4.00		3.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	2	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00		95.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	2	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.33	70.00	140.00	210.00																					2.33	70.00		200.00																		70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	2	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					527.05	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	024	0	1	01	01	H3949_024_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.33	10.00	20.00	30.00																					.33	10.00		21.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	2	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.13	4.00	8.00	12.00																					0.13	4.00		3.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	2	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.33	40.00	80.00	120.00																					1.33	40.00		110.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	2	6	Select Diabetic Drugs	1	4	010010	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00		5.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	2	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					609.17	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	2	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	027	0	1	02	01	H3949_027_0	2	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.23	7.00	14.00	21.00																					0.23	7.00		12.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	027	0	1	02	01	H3949_027_0	2	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	027	0	1	02	01	H3949_027_0	2	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.33	40.00	80.00	120.00																					1.33	40.00		110.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	027	0	1	02	01	H3949_027_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.33	10.00	20.00	30.00																					0.33	10.00		21.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	027	0	1	02	01	H3949_027_0	2	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					523.02	28	28	28																					28		28																	28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	7	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								8.00																		4.00				0.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.33	40.00		120.00																								80.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	7	1	Generic	3	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								8.00																		4.00				0.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3952	020	0	1	01	01	H3952_020_0	7	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		240.00																								160.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	7	4	Specialty Tier	1	4	110001	1	1	110		01	100		1	30		90				1			90				30		31					363.77	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	7	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								8.00																		4.00				0.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.33	40.00		120.00																								80.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	7	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		240.00																								160.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	7	4	Specialty Tier	1	4	110001	1	1	110		01	100		1	30		90				1			90				30		31					363.77	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	7	1	Generic	3	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								8.00																		4.00				0.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3952	049	0	1	01	01	H3952_049_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		24.00																								16.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	7	5	Specialty Tier	1	4	101101	1	1	110		01	100		1	30		90				1			90				30		31					437.63	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.00	90.00		270.00																								180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	7	5	Specialty Tier	1	4	101101	1	1	110		01	100		1	30		90				1			90				30		31					437.63	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	3.00	90.00		270.00																								180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.26	8.00		24.00																								16.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	021	0	1	01	01	H3954_021_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	021	0	1	01	01	H3954_021_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	021	0	1	01	01	H3954_021_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	021	0	1	01	01	H3954_021_0	5	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	021	0	1	01	01	H3954_021_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	021	0	1	01	01	H3954_021_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.23	69.00		207.00																								207.00																		69.00				2.23	69.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	027	0	1	01	01	H3954_027_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	027	0	1	01	01	H3954_027_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.23	69.00		207.00																								207.00																		69.00				2.23	69.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	027	0	1	01	01	H3954_027_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	027	0	1	01	01	H3954_027_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	027	0	1	01	01	H3954_027_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	027	0	1	01	01	H3954_027_0	5	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	033	0	1	01	01	H3954_033_0	5	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	033	0	1	01	01	H3954_033_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.23	69.00		207.00																								207.00																		69.00				2.23	69.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	033	0	1	01	01	H3954_033_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	033	0	1	01	01	H3954_033_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	033	0	1	01	01	H3954_033_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	033	0	1	01	01	H3954_033_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	100	0	1	01	01	H3954_100_0	4	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	100	0	1	01	01	H3954_100_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	100	0	1	01	01	H3954_100_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	100	0	1	01	01	H3954_100_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	100	0	1	01	01	H3954_100_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	100	0	1	01	01	H3954_100_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	137	0	1	01	01	H3954_137_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	137	0	1	01	01	H3954_137_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	137	0	1	01	01	H3954_137_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	137	0	1	01	01	H3954_137_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.23	69.00		207.00																								207.00																		69.00				2.23	69.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	137	0	1	01	01	H3954_137_0	5	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	137	0	1	01	01	H3954_137_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	139	0	1	01	01	H3954_139_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	139	0	1	01	01	H3954_139_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	139	0	1	01	01	H3954_139_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	139	0	1	01	01	H3954_139_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	139	0	1	01	01	H3954_139_0	4	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	139	0	1	01	01	H3954_139_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	141	0	1	02	01	H3954_141_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	141	0	1	02	01	H3954_141_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	141	0	1	02	01	H3954_141_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	141	0	1	02	01	H3954_141_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.23	69.00		207.00																								207.00																		69.00				2.23	69.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	141	0	1	02	01	H3954_141_0	4	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	141	0	1	02	01	H3954_141_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	143	0	1	02	01	H3954_143_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	143	0	1	02	01	H3954_143_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	143	0	1	02	01	H3954_143_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	143	0	1	02	01	H3954_143_0	4	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	143	0	1	02	01	H3954_143_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	143	0	1	02	01	H3954_143_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	146	0	1	01	01	H3954_146_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	146	0	1	01	01	H3954_146_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	146	0	1	01	01	H3954_146_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	146	0	1	01	01	H3954_146_0	6	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	146	0	1	01	01	H3954_146_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	146	0	1	01	01	H3954_146_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	148	0	1	01	01	H3954_148_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	148	0	1	01	01	H3954_148_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	148	0	1	01	01	H3954_148_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	148	0	1	01	01	H3954_148_0	5	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	148	0	1	01	01	H3954_148_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	148	0	1	01	01	H3954_148_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	151	0	1	02	01	H3954_151_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	151	0	1	02	01	H3954_151_0	4	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	151	0	1	02	01	H3954_151_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.23	69.00		207.00																								207.00																		69.00				2.23	69.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	151	0	1	02	01	H3954_151_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	151	0	1	02	01	H3954_151_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	151	0	1	02	01	H3954_151_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	153	0	1	02	01	H3954_153_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	153	0	1	02	01	H3954_153_0	4	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	153	0	1	02	01	H3954_153_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.23	69.00		207.00																								207.00																		69.00				2.23	69.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	153	0	1	02	01	H3954_153_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	153	0	1	02	01	H3954_153_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	153	0	1	02	01	H3954_153_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	155	0	1	02	01	H3954_155_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	155	0	1	02	01	H3954_155_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.23	7.00		21.00																								21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	155	0	1	02	01	H3954_155_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	155	0	1	02	01	H3954_155_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.23	69.00		207.00																								207.00																		69.00				2.23	69.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	155	0	1	02	01	H3954_155_0	4	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	155	0	1	02	01	H3954_155_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3957	003	0	1	01	01	H3957_003_0	11	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	.29	9.00		27.00																								22.50																		9.00				.29	9.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	11	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	11	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	11	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					982.78	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	11	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1100.95	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	11	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	11	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	11	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	.29	9.00		27.00																								22.50																		9.00				.29	9.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	11	1	Generic	3	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.25	8.00		24.00																								20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3957	020	0	1	01	01	H3957_020_0	11	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1072.18	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	11	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	11	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.35	42.00		126.00																								105.00																		42.00				1.35	42.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	11	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	.25	8.00		24.00																								20.00																		8.00				.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	11	1	Generic	3	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.25	8.00		24.00																								20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3957	021	0	1	01	01	H3957_021_0	11	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1154.79	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	11	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	.25	8.00		24.00																								20.00																		8.00				.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	11	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.35	42.00		126.00																								105.00																		42.00				1.35	42.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	11	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	11	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	11	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	11	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1105.48	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	11	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.32	10.00		30.00																								25.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	11	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.32	10.00		30.00																								25.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	11	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					988.26	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	11	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	11	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	036	0	1	01	01	H3957_036_0	11	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.64	20.00		60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	036	0	1	01	01	H3957_036_0	11	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1159.60	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	036	0	1	01	01	H3957_036_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	036	0	1	01	01	H3957_036_0	11	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	036	0	1	01	01	H3957_036_0	11	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	037	0	1	01	01	H3957_037_0	11	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	037	0	1	01	01	H3957_037_0	11	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	037	0	1	01	01	H3957_037_0	11	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.64	20.00		60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	037	0	1	01	01	H3957_037_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	.16	5.00		15.00																								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	037	0	1	01	01	H3957_037_0	11	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1325.11	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	16	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	16	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.00	30.00	60.00	90.00					0.66	20.00	40.00	50.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	16	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	16	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	16	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.26	8.00	16.00	24.00					0.16	5.00	10.00	12.50																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3959	001	0	1	01	01	H3959_001_0	16	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.26	8.00	16.00	24.00					0.16	5.00	10.00	12.50																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	9	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.26	8.00	16.00	24.00					0.16	5.00	10.00	12.50																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3959	002	0	1	01	01	H3959_002_0	9	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	9	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.00	30.00	60.00	90.00					0.66	20.00	40.00	50.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.26	8.00	16.00	24.00					0.16	5.00	10.00	12.50																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.63	19.00	38.00	57.00					1.10	33.00	66.00	99.00					0.63	19.00	38.00	47.50																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.86	86.00	172.00	258.00					3.16	95.00	190.00	285.00					2.86	86.00	172.00	258.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	8	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.26	8.00	16.00	24.00					0.16	5.00	10.00	12.50																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	9	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.63	19.00	38.00	57.00					1.10	33.00	66.00	99.00					0.63	19.00	38.00	47.50																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	9	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	180.00	270.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	9	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.20	6.00	12.00	18.00					0.30	9.00	18.00	27.00					0.20	6.00	12.00	15.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	031	0	1	01	01	H3959_031_0	8	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	031	0	1	01	01	H3959_031_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	031	0	1	01	01	H3959_031_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	180.00	270.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	031	0	1	01	01	H3959_031_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.10	33.00	66.00	99.00					0.66	20.00	40.00	50.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	031	0	1	01	01	H3959_031_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.30	9.00	18.00	27.00					0.13	4.00	8.00	10.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	14	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.63	19.00	38.00	57.00					1.10	33.00	66.00	99.00					0.63	19.00	38.00	47.50																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	14	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	14	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	14	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.13	34.00	68.00	102.00					1.50	45.00	90.00	135.00					1.13	34.00	68.00	85.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	14	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.26	8.00	16.00	24.00					0.13	4.00	8.00	10.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.20	6.00	12.00	18.00					0.30	9.00	18.00	27.00					0.20	6.00	12.00	15.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.10	33.00	66.00	99.00					0.66	20.00	40.00	50.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	8	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	180.00	270.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	16	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	16	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.66	80.00	160.00	240.00					3.16	95.00	190.00	285.00					2.66	80.00	160.00	240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	16	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	16	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.20	6.00	12.00	18.00					0.30	9.00	18.00	27.00					0.20	6.00	12.00	15.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3959	037	0	1	01	01	H3959_037_0	16	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.10	33.00	66.00	99.00					0.66	20.00	40.00	50.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	16	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.20	6.00	12.00	18.00					0.30	9.00	18.00	27.00					0.20	6.00	12.00	15.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		9.00					.26	8.00		24.00					.10	3.00		9.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.29	9.00		27.00					.45	14.00		42.00					.29	9.00		27.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.23	38.00		114.00					1.45	45.00		135.00					1.23	38.00		114.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.87	89.00		267.00					3.06	95.00		285.00					2.87	89.00		267.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													510.00	33							510.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		9.00					.26	8.00		24.00					.10	3.00		9.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3962	001	0	1	01	01	H3962_001_0	6	2	Non-Preferred Generic	3	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.29	9.00		27.00					.45	14.00		42.00					.29	9.00		27.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3962	004	0	1	01	01	H3962_004_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.13	4.00		12.00					.29	9.00		27.00					.13	4.00		12.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													575.00	33							575.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.87	89.00		267.00					3.06	95.00		285.00					2.87	89.00		267.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.23	38.00		114.00					1.45	45.00		135.00					1.23	38.00		114.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.39	12.00		36.00					.55	17.00		51.00					.39	12.00		36.00																		17.00				.55	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.48	15.00		45.00					.65	20.00		60.00					.48	15.00		45.00																		20.00				.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.16	5.00		15.00					.32	10.00		30.00					.16	5.00		15.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.29	40.00		120.00					1.45	45.00		135.00					1.29	40.00		120.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	7	4	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													566.00	33							566.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	11	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	11	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	11	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	11	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	12	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	12	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	12	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	001	0	1	02	01	H4003_001_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.13	4.00		12.00																								8.00																		4.00				.12	4.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	001	0	1	02	01	H4003_001_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.66	20.00		60.00																								40.00																		20.00				.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	001	0	1	02	01	H4003_001_0	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	1.66	50.00		150.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	001	0	1	02	01	H4003_001_0	8	4	Specialty Tier	1	4	001001	1	1	110		01	100		1	30		90				2			90				30		31					695.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	001	0	1	02	01	H4003_001_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.13	4.00		12.00																								8.00																		4.00				.12	4.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	009	0	1	01	01	H4003_009_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H4003	009	0	1	01	01	H4003_009_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H4003	009	0	1	01	01	H4003_009_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.10	3.00		9.00																								6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H4003	009	0	1	01	01	H4003_009_0	8	4	Specialty Tier	1	4	001001	1	1	110		01	100		1	30		90				2			90				30		31					695.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H4003	009	0	1	01	01	H4003_009_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier, Select Diabetic Drugs										2		
H4003	009	0	1	01	01	H4003_009_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.10	3.00		9.00																								6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier, Select Diabetic Drugs										2		
H4003	009	0	1	01	01	H4003_009_0	8	5	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H4003	015	0	1	01	01	H4003_015_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.23	7.00		21.00																								14.00																		7.00				.22	7.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	015	0	1	01	01	H4003_015_0	6	4	Specialty Tier	1	4	001001	1	1	110		01	100		1	30		90				2			90				30		31					695.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	015	0	1	01	01	H4003_015_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.00	60.00		180.00																								120.00																		60.00				1.93	60.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	015	0	1	01	01	H4003_015_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.33	40.00		120.00																								80.00																		40.00				1.29	40.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	015	0	1	01	01	H4003_015_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.23	7.00		21.00																								14.00																		7.00				.22	7.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	019	0	1	01	01	H4003_019_0	7	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.00	60.00		180.00																								120.00																		60.00				1.93	60.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		90.00																								60.00																		30.00				.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.13	4.00		12.00																								8.00																		4.00				.12	4.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	7	4	Specialty Tier	1	4	001001	1	1	110		01	100		1	30		90				2			90				30		31					695.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.13	4.00		12.00																								8.00																		4.00				.12	4.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	025	0	1	02	01	H4003_025_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	025	0	1	02	01	H4003_025_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.06	2.00		6.00																								4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	025	0	1	02	01	H4003_025_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.83	25.00		75.00																								50.00																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	025	0	1	02	01	H4003_025_0	8	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				2			90				30		31	1.66	50.00		150.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	025	0	1	02	01	H4003_025_0	8	5	Specialty Tier	1	4	001001	1	1	110		01	100		1	30		90				2			90				30		31					834.00	30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	025	0	1	02	01	H4003_025_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.06	2.00		6.00																								4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	025	0	1	02	01	H4003_025_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	027	0	1	02	01	H4003_027_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.33	40.00		120.00																								80.00																		40.00				1.29	40.00		Preferred Generic, Preferred Brand, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Preferred Brand, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_0	8	3	Specialty Tier	1	4	001001	1	1	110		01	100		1	30		90				2			90				30		31					695.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Preferred Brand, Specialty Tier										2		
H4004	015	0	1	02	01	H4004_015_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	015	0	1	02	01	H4004_015_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.96	29.00		87.00																								58.00																		29.00				.93	29.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	015	0	1	02	01	H4004_015_0	7	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	1.66	50.00		150.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	015	0	1	02	01	H4004_015_0	7	4	Specialty Tier	1	4	001001	1	1	110		01	100		1	30		90				2			90				30		31					695.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	015	0	1	02	01	H4004_015_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4004	050	0	1	01	01	H4004_050_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.23	7.00		21.00																								14.00																		7.00				.22	7.00		Preferred Generic, Preferred Brand, Specialty Tier												
H4004	050	0	1	01	01	H4004_050_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.16	35.00		105.00																								70.00																		35.00				1.12	35.00		Preferred Generic, Preferred Brand, Specialty Tier												
H4004	050	0	1	01	01	H4004_050_0	7	3	Specialty Tier	1	4	001001	1	1	110		01	100		1	30		90				2			90				30		31					695.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Specialty Tier												
H4004	050	0	1	01	01	H4004_050_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.23	7.00		21.00																								14.00																		7.00				.22	7.00		Preferred Generic, Preferred Brand, Specialty Tier										2		
H4004	053	0	1	02	01	H4004_053_0	9	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.33	40.00		120.00																								80.00																		40.00				1.29	40.00		Preferred Generic, Preferred Brand, Specialty Tier												
H4004	053	0	1	02	01	H4004_053_0	9	3	Specialty Tier	1	4	001001	1	1	110		01	100		1	30		90				2			90				30		31					695.00	25		25																							25																	25				25	Preferred Generic, Preferred Brand, Specialty Tier												
H4004	053	0	1	02	01	H4004_053_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Preferred Brand, Specialty Tier										2		
H4004	053	0	1	02	01	H4004_053_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	12	1	Preferred Generic	3	4	001000	3	2		110	01	100		1				30		90	1			90				30		31									.17	5.00		15.00					.23	7.00		21.00								10.00																		7.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4005	004	0	1	04	01	H4005_004_0	12	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	33		33							25																	33				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	12	4	Non-Preferred Brand	1	4	100000	3	3		110	01	100		1				30		90	1			90				30		31									1.17	35.00		105.00	1.00	25		25	1.33	40.00		120.00	1.00	25		25				70.00			25															40.00		25		1.13	35.00	25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	12	3	Preferred Brand	1	4	000001	3	2		110	01	100		1				30		90	1			90				30		31									.67	20.00		60.00					.83	25.00		75.00								40.00																		25.00				.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	12	2	Non-Preferred Generic	1	4	000100	3	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.40	12.00		36.00								20.00																		12.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	12	1	Preferred Generic	1	4	001000	3	2		110	01	100		1				30		90	1			90				30		31									.17	5.00		15.00					.23	7.00		21.00								10.00																		7.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	12	2	Non-Preferred Generic	3	4	000100	3	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.40	12.00		36.00								20.00																		12.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4006	007	0	1	01	01	H4006_007_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.13	4.00		12.00																					0.13	4.00		8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4006	007	0	1	01	01	H4006_007_0	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.17	5.00		15.00																					0.17	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4006	007	0	1	01	01	H4006_007_0	12	3	Preferred Brand	1	4	000001	3	2	110		01	110		1	30		90				1	30		90				30		31	0.97	29.00		87.00																					0.97	29.00		58.00																		29.00				0.94	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4006	007	0	1	01	01	H4006_007_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	1.67	50.00		150.00																					1.67	50.00		100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4006	007	0	1	01	01	H4006_007_0	12	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	30							30						30		31					809.48	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4006	007	0	1	01	01	H4006_007_0	12	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.13	4.00		12.00																					0.13	4.00		8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4006	007	0	1	01	01	H4006_007_0	12	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.17	5.00		15.00																					0.17	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4006	008	0	1	02	01	H4006_008_0	14	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4006	008	0	1	02	01	H4006_008_0	14	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	30							30						30		31					613.24	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4006	008	0	1	02	01	H4006_008_0	14	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	1.13	34.00		102.00																					1.10	34.00		34.00																		34.00				1.10	34.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4006	008	0	1	02	01	H4006_008_0	14	3	Preferred Brand	1	4	000001	3	2	110		01	110		1	30		90				1	30		90				30		31	0.60	18.00		54.00																					0.60	18.00		18.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4006	008	0	1	02	01	H4006_008_0	14	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.10	3.00		9.00																					0.10	3.00		3.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4006	008	0	1	02	01	H4006_008_0	14	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4006	008	0	1	02	01	H4006_008_0	14	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.10	3.00		9.00																					0.10	3.00		3.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4007	005	0	1	01	01	H4007_005_0	6	3	Non-Preferred Brand	1	3	100100	1	1	110		01	110		1	30		90				2	30		90				30		31					41.00	25		25																					25		25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4007	005	0	1	01	01	H4007_005_0	6	2	Preferred Brand	1	3	000101	1	1	110		01	110		1	30		90				2	30		90				30		31					39.00	25		25																					25		25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4007	005	0	1	01	01	H4007_005_0	6	1	Preferred Generic	1	3	001010	1	1	110		01	110		1	30		90				2	30		90				30		31					3.00	25		25																					25		25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4007	012	0	1	01	01	H4007_012_0	5	4	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4007	012	0	1	01	01	H4007_012_0	5	2	Preferred Brand	3	4	010001	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		35.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	012	0	1	01	01	H4007_012_0	5	3	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	5	2	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		35.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	5	3	Non-Preferred Brand	3	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00	30.00		90.00																												1.00	30.00		80.00				1.00	30.00		90.00				30.00				0.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	012	0	1	01	01	H4007_012_0	5	4	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	013	0	1	01	01	H4007_013_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4007	013	0	1	01	01	H4007_013_0	5	2	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.83	25.00		75.00																												0.83	25.00		65.00				0.83	25.00		75.00				25.00				0.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4007	013	0	1	01	01	H4007_013_0	5	3	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4007	013	0	1	01	01	H4007_013_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand										2	3	1
H4007	013	0	1	01	01	H4007_013_0	5	2	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.83	25.00		75.00																												0.83	25.00		65.00				0.83	25.00		75.00				25.00				0.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand										2	3	
H4007	013	0	1	01	01	H4007_013_0	5	3	Non-Preferred Brand	3	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand										2	1	
H4007	016	0	1	01	01	H4007_016_0	6	1	Preferred Generic	1	3	001010	1	1	110		01	110		1	30		90				2	30		90				30		31					3.00	25		25																					25		25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4007	016	0	1	01	01	H4007_016_0	6	2	Preferred Brand	1	3	000101	1	1	110		01	110		1	30		90				2	30		90				30		31					45.00	25		25																					25		25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4007	016	0	1	01	01	H4007_016_0	6	3	Non-Preferred Brand	1	3	100100	1	1	110		01	110		1	30		90				2	30		90				30		31					66.00	25		25																					25		25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H4011	003	0	1	04	01	H4011_003_0	12	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.17	35.00		105.00																								70.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4011	003	0	1	04	01	H4011_003_0	12	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.40	12.00		36.00																								24.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4011	003	0	1	04	01	H4011_003_0	12	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.20	6.00		18.00																								12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4011	003	0	1	04	01	H4011_003_0	12	5	Specialty Tier	1	4	010010	1	1	110		01			1	30		90				2							30		31						25		25																																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4011	003	0	1	04	01	H4011_003_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	1.83	55.00		165.00																								110.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4011	003	0	1	04	01	H4011_003_0	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.40	12.00		36.00																								24.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4011	003	0	1	04	01	H4011_003_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.20	6.00		18.00																								12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4012	008	0	1	01	01	H4012_008_0	12	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.67	20.00		60.00								20.00																		20.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4012	008	0	1	01	01	H4012_008_0	12	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.23	7.00		21.00								10.00																		7.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4012	008	0	1	01	01	H4012_008_0	12	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31													1.00	33		33					1.00	33		33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4012	008	0	1	01	01	H4012_008_0	12	4	Non-Preferred Brand	1	4	100000	1	3		110	01	100		1				30		90	1			90				30		31									1.33	40.00		120.00	1.00	25		25	1.67	50.00		150.00	1.00	25		25				80.00			25															50.00		25		1.29	40.00	25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4012	008	0	1	01	01	H4012_008_0	12	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.17	35.00		105.00					1.33	40.00		120.00								70.00																		40.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4012	008	0	1	01	01	H4012_008_0	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.67	20.00		60.00								20.00																		20.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4012	008	0	1	01	01	H4012_008_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.17	5.00		15.00					.23	7.00		21.00								10.00																		7.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4036	004	0	1	04	01	H4036_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.21	7.00	14.00	21.00					.35	12.00	24.00	36.00					.21	7.00	14.00	14.00																		12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	004	0	1	04	01	H4036_004_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.03	1.00	2.00	3.00					.18	6.00	12.00	18.00					.03	1.00	2.00	2.00																		6.00				.18	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	004	0	1	04	01	H4036_004_0	5	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	004	0	1	04	01	H4036_004_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	004	0	1	04	01	H4036_004_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													73.00	33	33	33					73.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	004	0	1	04	01	H4036_004_0	5	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	005	0	1	04	01	H4036_005_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.44	15.00	30.00	45.00					.59	20.00	40.00	60.00					.44	15.00	30.00	30.00																		20.00				.59	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	005	0	1	04	01	H4036_005_0	6	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.12	4.00	8.00	12.00					.26	9.00	18.00	27.00					.12	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	005	0	1	04	01	H4036_005_0	6	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.03	35.00	70.00	105.00					1.18	40.00	80.00	120.00					1.03	35.00	105.00	105.00																		40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	005	0	1	04	01	H4036_005_0	6	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	005	0	1	04	01	H4036_005_0	6	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													73.00	33	33	33					73.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	005	0	1	04	01	H4036_005_0	6	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.50	85.00	170.00	255.00					2.65	90.00	180.00	270.00					2.50	85.00	255.00	255.00																		90.00				2.65	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	007	0	1	04	01	H4036_007_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.12	4.00	8.00	12.00					.26	9.00	18.00	27.00					.12	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	007	0	1	04	01	H4036_007_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.44	15.00	30.00	45.00					.59	20.00	40.00	60.00					.44	15.00	30.00	30.00																		20.00				.59	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	007	0	1	04	01	H4036_007_0	4	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													73.00	33	33	33					73.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	007	0	1	04	01	H4036_007_0	4	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	007	0	1	04	01	H4036_007_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4036	007	0	1	04	01	H4036_007_0	4	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4102	001	0	1	01	01	H4102_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	001	0	1	01	01	H4102_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	001	0	1	01	01	H4102_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					543.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	001	0	1	01	01	H4102_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4102	001	0	1	01	01	H4102_001_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4123	001	0	1	02	01	H4123_001_0	6	3	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	2.80	85.00	170.00	255.00																					2.80	85.00	170.00	212.50																		85.00				2.50	85.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4123	001	0	1	02	01	H4123_001_0	6	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		34					200.00	33																							33																			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4123	001	0	1	02	01	H4123_001_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.20	6.00	12.00	18.00																					.20	6.00	12.00	15.00																		6.00				.17	6.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4123	001	0	1	02	01	H4123_001_0	6	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	112.50																		45.00				1.32	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4123	004	0	1	02	01	H4123_004_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4123	004	0	1	02	01	H4123_004_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		34					200.00	33																							33																			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4123	004	0	1	02	01	H4123_004_0	8	3	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	2.50	75.00	150.00	225.00																					2.50	75.00	150.00	187.50																		75.00				2.20	75.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4123	004	0	1	02	01	H4123_004_0	8	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	1.33	40.00	80.00	120.00																					1.33	40.00	80.00	100.00																		40.00				1.17	40.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4125	001	0	1	01	01	H4125_001_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.06	2.00	4.00	6.00																					0.06	2.00		0.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4125	001	0	1	01	01	H4125_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.36	11.00	22.00	33.00																					0.36	11.00		24.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4125	001	0	1	01	01	H4125_001_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4125	001	0	1	01	01	H4125_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00		275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4125	001	0	1	01	01	H4125_001_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					589.99	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	001	0	1	01	01	H4141_001_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4141	001	0	1	01	01	H4141_001_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	001	0	1	01	01	H4141_001_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	001	0	1	01	01	H4141_001_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	001	0	1	01	01	H4141_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4141	004	0	1	01	01	H4141_004_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	26																														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	004	0	1	01	01	H4141_004_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	26																														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	004	0	1	01	01	H4141_004_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	004	0	1	01	01	H4141_004_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	006	0	1	01	01	H4141_006_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4141	006	0	1	01	01	H4141_006_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	006	0	1	01	01	H4141_006_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	006	0	1	01	01	H4141_006_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	006	0	1	01	01	H4141_006_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	006	0	1	01	01	H4141_006_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	006	0	1	01	01	H4141_006_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	006	0	1	01	01	H4141_006_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	006	0	1	01	01	H4141_006_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	006	0	1	01	01	H4141_006_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	007	0	1	01	01	H4141_007_0	6	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	007	0	1	01	01	H4141_007_0	6	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	007	0	1	01	01	H4141_007_0	6	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	007	0	1	01	01	H4141_007_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	007	0	1	01	01	H4141_007_0	6	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_008_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	008	0	1	01	01	H4141_008_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	008	0	1	01	01	H4141_008_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	008	0	1	01	01	H4141_008_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	008	0	1	01	01	H4141_008_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4141	008	0	1	01	01	H4141_008_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_008_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_008_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_008_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_008_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	009	0	1	01	01	H4141_009_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	009	0	1	01	01	H4141_009_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	009	0	1	01	01	H4141_009_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	009	0	1	01	01	H4141_009_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	009	0	1	01	01	H4141_009_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	009	0	1	01	01	H4141_009_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4141	009	0	1	01	01	H4141_009_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	009	0	1	01	01	H4141_009_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	009	0	1	01	01	H4141_009_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	009	0	1	01	01	H4141_009_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	010	0	1	01	01	H4141_010_0	7	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.36	11.00		33.00																												0.36	11.00		0.00				0.36	11.00		33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	010	0	1	01	01	H4141_010_0	7	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	010	0	1	01	01	H4141_010_0	7	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	010	0	1	01	01	H4141_010_0	7	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	010	0	1	01	01	H4141_010_0	7	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	011	0	1	01	01	H4141_011_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4141	011	0	1	01	01	H4141_011_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	011	0	1	01	01	H4141_011_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	011	0	1	01	01	H4141_011_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	011	0	1	01	01	H4141_011_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	011	0	1	01	01	H4141_011_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	011	0	1	01	01	H4141_011_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	011	0	1	01	01	H4141_011_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	011	0	1	01	01	H4141_011_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	011	0	1	01	01	H4141_011_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	012	0	1	01	01	H4141_012_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	012	0	1	01	01	H4141_012_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	012	0	1	01	01	H4141_012_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	012	0	1	01	01	H4141_012_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	012	0	1	01	01	H4141_012_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	012	0	1	01	01	H4141_012_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4141	012	0	1	01	01	H4141_012_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	012	0	1	01	01	H4141_012_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	012	0	1	01	01	H4141_012_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	012	0	1	01	01	H4141_012_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	013	0	1	01	01	H4141_013_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.56	17.00		51.00																												0.56	17.00		0.00				0.56	17.00		51.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	013	0	1	01	01	H4141_013_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	013	0	1	01	01	H4141_013_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	013	0	1	01	01	H4141_013_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	013	0	1	01	01	H4141_013_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	013	0	1	01	01	H4141_013_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.56	17.00		51.00																												0.56	17.00		0.00				0.56	17.00		51.00				17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	013	0	1	01	01	H4141_013_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	013	0	1	01	01	H4141_013_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	013	0	1	01	01	H4141_013_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	013	0	1	01	01	H4141_013_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4145	001	0	1	01	01	H4145_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4145	001	0	1	01	01	H4145_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4145	001	0	1	01	01	H4145_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4145	001	0	1	01	01	H4145_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4145	001	0	1	01	01	H4145_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4145	001	0	1	01	01	H4145_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4145	001	0	1	01	01	H4145_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4145	001	0	1	01	01	H4145_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4145	001	0	1	01	01	H4145_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4145	001	0	1	01	01	H4145_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	5	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	5	3	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	5	2	Preferred Brand	1	4	000101	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	5	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	.13	4.00	8.00	12.00																								8.00																		4.00				.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	5	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	5	3	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	5	2	Preferred Brand	1	4	000101	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	5	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								8.00																		4.00				.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	5	1	Generic	3	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								8.00																		4.00				.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4152	013	0	1	01	01	H4152_013_0	5	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	.13	4.00	8.00	12.00																								8.00																		4.00				.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	5	2	Preferred Brand	1	4	000101	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	5	3	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	5	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	6	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	6	2	Preferred Brand	1	4	000101	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	6	3	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	6	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31						30																							30																			30				30	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	001	0	1	01	01	H4199_001_0	7	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	001	0	1	01	01	H4199_001_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	001	0	1	01	01	H4199_001_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	001	0	1	01	01	H4199_001_0	7	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					507.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	001	0	1	01	01	H4199_001_0	7	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	002	0	1	01	01	H4199_002_0	6	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	002	0	1	01	01	H4199_002_0	6	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	002	0	1	01	01	H4199_002_0	6	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	.65	20.00		60.00																								60.00																		20.00				.60	20.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	002	0	1	01	01	H4199_002_0	6	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					430.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	002	0	1	01	01	H4199_002_0	6	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	005	0	1	01	01	H4199_005_0	5	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	005	0	1	01	01	H4199_005_0	5	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	005	0	1	01	01	H4199_005_0	5	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	.65	20.00		60.00																								60.00																		20.00				.60	20.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	005	0	1	01	01	H4199_005_0	5	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	005	0	1	01	01	H4199_005_0	5	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					879.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	006	0	1	01	01	H4199_006_0	6	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	006	0	1	01	01	H4199_006_0	6	2	Preferred Brand	1	4	000001	3	1	110		01	100		1	30		90				1			90				30		31					41.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	006	0	1	01	01	H4199_006_0	6	3	Non-Preferred Brand	1	4	100000	3	1	110		01	100		1	30		90				1			90				30		31					77.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	006	0	1	01	01	H4199_006_0	6	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					610.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	006	0	1	01	01	H4199_006_0	6	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	007	0	1	01	01	H4199_007_0	8	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	007	0	1	01	01	H4199_007_0	8	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	.32	10.00		30.00																								30.00																		10.00				.31	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	007	0	1	01	01	H4199_007_0	8	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					909.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	007	0	1	01	01	H4199_007_0	8	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.30	40.00		120.00																								120.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	007	0	1	01	01	H4199_007_0	8	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	008	0	1	01	01	H4199_008_0	6	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.95	60.00		180.00																								180.00																		60.00				1.90	60.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	008	0	1	01	01	H4199_008_0	6	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					798.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	008	0	1	01	01	H4199_008_0	6	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	008	0	1	01	01	H4199_008_0	6	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	008	0	1	01	01	H4199_008_0	6	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	.65	20.00		60.00																								60.00																		20.00				.65	20.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	010	0	1	01	01	H4199_010_0	5	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	010	0	1	01	01	H4199_010_0	5	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	.32	10.00		30.00																								30.00																		10.00				.30	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	010	0	1	01	01	H4199_010_0	5	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.30	40.00		120.00																								120.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	010	0	1	01	01	H4199_010_0	5	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					820.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	010	0	1	01	01	H4199_010_0	5	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	011	0	1	01	01	H4199_011_0	7	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					611.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	011	0	1	01	01	H4199_011_0	7	3	Non-Preferred Brand	1	4	100000	3	1	110		01	100		1	30		90				1			90				30		31					77.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	011	0	1	01	01	H4199_011_0	7	2	Preferred Brand	1	4	000001	3	1	110		01	100		1	30		90				1			90				30		31					41.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	011	0	1	01	01	H4199_011_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	011	0	1	01	01	H4199_011_0	7	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	012	0	1	01	01	H4199_012_0	8	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	012	0	1	01	01	H4199_012_0	8	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	.32	10.00		30.00																								30.00																		10.00				.31	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	012	0	1	01	01	H4199_012_0	8	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.30	40.00		120.00																								120.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	012	0	1	01	01	H4199_012_0	8	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					906.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	012	0	1	01	01	H4199_012_0	8	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	013	0	1	01	01	H4199_013_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	013	0	1	01	01	H4199_013_0	7	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	.65	20.00		60.00																								60.00																		20.00				.65	20.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	013	0	1	01	01	H4199_013_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.95	60.00		180.00																								180.00																		60.00				1.90	60.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	013	0	1	01	01	H4199_013_0	7	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					794.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	013	0	1	01	01	H4199_013_0	7	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	015	0	1	01	01	H4199_015_0	5	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					816.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	015	0	1	01	01	H4199_015_0	5	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.30	40.00		120.00																								120.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	015	0	1	01	01	H4199_015_0	5	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	.32	10.00		30.00																								30.00																		10.00				.30	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	015	0	1	01	01	H4199_015_0	5	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	015	0	1	01	01	H4199_015_0	5	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	016	0	1	01	01	H4199_016_0	6	2	Preferred Brand	1	4	000001	3	1	110		01	100		1	30		90				1			90				30		31					41.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	016	0	1	01	01	H4199_016_0	6	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	016	0	1	01	01	H4199_016_0	6	3	Non-Preferred Brand	1	4	100000	3	1	110		01	100		1	30		90				1			90				30		31					77.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	016	0	1	01	01	H4199_016_0	6	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					611.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	016	0	1	01	01	H4199_016_0	6	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	017	0	1	01	01	H4199_017_0	8	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	017	0	1	01	01	H4199_017_0	8	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	.32	10.00		30.00																								30.00																		10.00				.31	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	017	0	1	01	01	H4199_017_0	8	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.30	40.00		120.00																								120.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	017	0	1	01	01	H4199_017_0	8	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					908.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	017	0	1	01	01	H4199_017_0	8	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	018	0	1	01	01	H4199_018_0	7	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	.65	20.00		60.00																								60.00																		20.00				.65	20.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	018	0	1	01	01	H4199_018_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	018	0	1	01	01	H4199_018_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.95	60.00		180.00																								180.00																		60.00				1.90	60.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	018	0	1	01	01	H4199_018_0	7	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	018	0	1	01	01	H4199_018_0	7	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					797.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	020	0	1	01	01	H4199_020_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	020	0	1	01	01	H4199_020_0	7	2	Preferred Brand	1	4	000001	3	2	110		01	100		1	30		90				1			90				30		31	.32	10.00		30.00																								30.00																		10.00				.30	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	020	0	1	01	01	H4199_020_0	7	3	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.30	40.00		120.00																								120.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	020	0	1	01	01	H4199_020_0	7	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					826.00	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	020	0	1	01	01	H4199_020_0	7	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4199	021	0	1	01	01	H4199_021_0	7	1	Generic	1	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	021	0	1	01	01	H4199_021_0	7	2	Preferred Brand	1	4	000001	3	1	110		01	100		1	30		90				1			90				30		31					41.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	021	0	1	01	01	H4199_021_0	7	4	Specialty Tier	1	4	010010	3	1	110		01	100		1	30		90				1			90				30		31					611.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	021	0	1	01	01	H4199_021_0	7	3	Non-Preferred Brand	1	4	100000	3	1	110		01	100		1	30		90				1			90				30		31					77.00	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4199	021	0	1	01	01	H4199_021_0	7	1	Generic	3	4	010000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4209	001	0	1	04	01	H4209_001_0	11	3	Preferred Brand	1	4	000001	1	2	111		01		110	1	31	60	90				1				31		90	31		31	1.45	45.00	90.00	135.00																												1.45	45.00		112.50				1.45	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	001	0	1	04	01	H4209_001_0	11	2	Non-Preferred Generic	3	4	000100	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.48	15.00	30.00	45.00																												.48	15.00		37.50				.48	15.00		45.00				15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4209	001	0	1	04	01	H4209_001_0	11	1	Preferred Generic	3	4	001000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.06	2.00	4.00	6.00																												.06	2.00		4.00				.06	2.00		6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4209	001	0	1	04	01	H4209_001_0	11	5	Specialty Tier	1	4	010010	1	1	111		01		110	1	31	60	90				1				31		90	31		31						27	27	27																												27		27					27		27			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	001	0	1	04	01	H4209_001_0	11	4	Non-Preferred Brand	1	4	110000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	2.74	85.00	170.00	255.00																												2.74	85.00		212.50				2.74	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	001	0	1	04	01	H4209_001_0	11	2	Non-Preferred Generic	1	4	000100	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.48	15.00	30.00	45.00																												0.48	15.00		37.50				0.48	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	001	0	1	04	01	H4209_001_0	11	1	Preferred Generic	1	4	001000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.06	2.00	4.00	6.00																												.06	2.00		4.00				.06	2.00		6.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	003	0	1	04	01	H4209_003_0	12	3	Preferred Brand	1	4	000001	1	2	111		01		110	1	31	60	90				1				31		90	31		31	1.45	45.00	90.00	135.00																												1.45	45.00		112.50				1.45	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	003	0	1	04	01	H4209_003_0	12	2	Non-Preferred Generic	1	4	000100	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.48	15.00	30.00	45.00																												0.48	15.00		37.50				0.48	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	003	0	1	04	01	H4209_003_0	12	1	Preferred Generic	1	4	001000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.06	2.00	4.00	6.00																												.06	2.00		4.00				.06	2.00		6.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	003	0	1	04	01	H4209_003_0	12	2	Non-Preferred Generic	3	4	000100	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.48	15.00	30.00	45.00																												.48	15.00		37.50				.48	15.00		45.00				15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4209	003	0	1	04	01	H4209_003_0	12	4	Non-Preferred Brand	1	4	110000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	2.74	85.00	170.00	255.00																												2.74	85.00		212.50				2.74	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	003	0	1	04	01	H4209_003_0	12	5	Specialty Tier	1	4	010010	1	1	111		01		110	1	31	60	90				1				31		90	31		31						27	27	27																												27		27					27		27			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	003	0	1	04	01	H4209_003_0	12	1	Preferred Generic	3	4	001000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.06	2.00	4.00	6.00																												.06	2.00		4.00				.06	2.00		6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4209	009	0	1	04	01	H4209_009_0	10	2	Non-Preferred Generic	3	4	000100	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.48	15.00	30.00	45.00																												.48	15.00		37.50				.48	15.00		45.00				15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4209	009	0	1	04	01	H4209_009_0	10	1	Preferred Generic	3	4	001000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.06	2.00	4.00	6.00																												.06	2.00		4.00				.06	2.00		6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4209	009	0	1	04	01	H4209_009_0	10	4	Non-Preferred Brand	1	4	110000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	2.74	85.00	170.00	255.00																												2.74	85.00		212.50				2.74	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	009	0	1	04	01	H4209_009_0	10	5	Specialty Tier	1	4	010010	1	1	111		01		110	1	31	60	90				1				31		90	31		31						27	27	27																												27		27					27		27			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	009	0	1	04	01	H4209_009_0	10	3	Preferred Brand	1	4	000001	1	2	111		01		110	1	31	60	90				1				31		90	31		31	1.45	45.00	90.00	135.00																												1.45	45.00		112.50				1.45	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	009	0	1	04	01	H4209_009_0	10	2	Non-Preferred Generic	1	4	000100	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.48	15.00	30.00	45.00																												0.48	15.00		37.50				0.48	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4209	009	0	1	04	01	H4209_009_0	10	1	Preferred Generic	1	4	001000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.06	2.00	4.00	6.00																												.06	2.00		4.00				.06	2.00		6.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4211	001	0	1	01	01	H4211_001_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4211	001	0	1	01	01	H4211_001_0	6	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4211	001	0	1	01	01	H4211_001_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4211	001	0	1	01	01	H4211_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4211	001	0	1	01	01	H4211_001_0	6	3	Preferred Brand	1	4	000001	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.57	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4211	001	0	1	01	01	H4211_001_0	6	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4211	001	0	1	01	01	H4211_001_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4211	003	0	1	01	01	H4211_003_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31						33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4211	003	0	1	01	01	H4211_003_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.10	3.00	6.00	9.00																					.10	3.00	4.50	6.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4211	003	0	1	01	01	H4211_003_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	142.50	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4211	003	0	1	01	01	H4211_003_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.16	36.00	72.00	108.00																					1.16	36.00	54.00	72.00																		36.00				1.16	36.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4211	003	0	1	01	01	H4211_003_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.19	6.00	12.00	18.00																					.19	6.00	9.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4211	003	0	1	01	01	H4211_003_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.10	3.00	6.00	9.00																					.10	3.00	4.50	6.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	004	0	1	09	04	H4213_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.50	15.00		37.50																					.50	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	004	0	1	09	04	H4213_004_0	6	3	Preferred Brand	1	4	000001	1	1	110		01	110		1	30		90				1	30		90				30		31					50.97	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	004	0	1	09	04	H4213_004_0	6	4	Non-Preferred Brand	1	4	110000	1	1	110		01	110		1	30		90				1	30		90				30		31					30.35	50		50																					50		50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	004	0	1	09	04	H4213_004_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		3.00																					.10	3.00		3.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	004	0	1	09	04	H4213_004_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					511.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	005	0	1	09	04	H4213_005_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		3.00																					.10	3.00		3.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	005	0	1	09	04	H4213_005_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.50	15.00		37.50																					.50	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	005	0	1	09	04	H4213_005_0	6	3	Preferred Brand	1	4	000001	1	1	110		01	110		1	30		90				1	30		90				30		31					50.97	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	005	0	1	09	04	H4213_005_0	6	4	Non-Preferred Brand	1	4	110000	1	1	110		01	110		1	30		90				1	30		90				30		31					30.35	50		50																					50		50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	005	0	1	09	04	H4213_005_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					511.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	006	0	1	09	04	H4213_006_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		3.00																					.10	3.00		3.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	006	0	1	09	04	H4213_006_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.50	15.00		37.50																					.50	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	006	0	1	09	04	H4213_006_0	4	3	Preferred Brand	1	4	000001	1	1	110		01	110		1	30		90				1	30		90				30		31					50.97	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	006	0	1	09	04	H4213_006_0	4	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					511.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	006	0	1	09	04	H4213_006_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01	110		1	30		90				1	30		90				30		31					30.35	50		50																					50		50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	007	0	1	09	04	H4213_007_0	7	4	Non-Preferred Brand	1	4	110000	1	1	110		01	110		1	30		90				1	30		90				30		31					30.35	50		50																					50		50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	007	0	1	09	04	H4213_007_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		3.00																					.10	3.00		3.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	007	0	1	09	04	H4213_007_0	7	3	Preferred Brand	1	4	000001	1	1	110		01	110		1	30		90				1	30		90				30		31					50.97	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	007	0	1	09	04	H4213_007_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.50	15.00		37.50																					.50	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	007	0	1	09	04	H4213_007_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					511.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4268	002	0	1	09	04	H4268_002_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4268	002	0	1	09	04	H4268_002_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4268	002	0	1	09	04	H4268_002_0	5	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.13	4.00		12.00																					0.13	4.00		10.00																		4.00				0.12	4.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4268	002	0	1	09	04	H4268_002_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4270	003	0	1	02	01	H4270_003_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	2.66	80.00		200.00																								160.00																			80.00			2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4270	003	0	1	02	01	H4270_003_0	8	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	1.33	40.00		100.00																								80.00																			40.00			1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4270	003	0	1	02	01	H4270_003_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	.50	15.00		37.50																								30.00																			15.00			0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4270	003	0	1	02	01	H4270_003_0	8	5	Specialty Tier	1	4	010010	1	1	110		10	100		1	30		90				1			90					29	31					1087.62	25		25																							25																		25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4270	003	0	1	02	01	H4270_003_0	8	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	.16	5.00		12.50																								10.00																			5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4270	006	0	1	02	01	H4270_006_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	3.00	90.00		270.00																								180.00																			90.00			2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4270	006	0	1	02	01	H4270_006_0	6	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	1.50	45.00		135.00																								90.00																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4270	006	0	1	02	01	H4270_006_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	.83	25.00		75.00																								50.00																			25.00			.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4270	006	0	1	02	01	H4270_006_0	6	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	.16	5.00		15.00																								10.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4270	006	0	1	02	01	H4270_006_0	6	5	Specialty Tier	1	4	010010	1	1	110		10	100		1	30		90				1			90					29	31					1435.66	33		33																							33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	8	4	Specialty Tier	1	2	110001	1	1	010		01			1	31													31		31					440.00	25																																										25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	8	3	Non-Preferred Brand	1	2	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	8	2	Preferred Brand	1	2	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								120.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	8	1	Generic	1	2	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.19	6.00		18.00																								18.00																		6.00				.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	8	5	Select Care Drugs	1	2	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	8	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4346	001	0	1	01	01	H4346_001_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	001	0	1	01	01	H4346_001_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	001	0	1	01	01	H4346_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	8	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	13	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4346	005	0	1	01	01	H4346_005_0	13	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4346	005	0	1	01	01	H4346_005_0	13	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	005	0	1	01	01	H4346_005_0	13	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	005	0	1	01	01	H4346_005_0	13	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	13	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	13	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	13	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	13	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	13	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	005	0	1	01	01	H4346_005_0	13	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	8	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	006	0	1	01	01	H4346_006_0	8	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4346	006	0	1	01	01	H4346_006_0	8	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4346	006	0	1	01	01	H4346_006_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	006	0	1	01	01	H4346_006_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	006	0	1	01	01	H4346_006_0	8	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	8	4	Non-Preferred Brand	3	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4346	008	0	1	01	01	H4346_008_0	8	6	Select Care Drugs	3	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	008	0	1	01	01	H4346_008_0	8	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4346	008	0	1	01	01	H4346_008_0	8	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	008	0	1	01	01	H4346_008_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	008	0	1	01	01	H4346_008_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.12	35.00		105.00					1.29	40.00		120.00								87.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.74	85.00		255.00					3.06	95.00		285.00								212.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	8	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.29	40.00		120.00					1.45	45.00		135.00								100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.90	90.00		270.00					3.06	95.00		285.00								225.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													428.00	33							428.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.32	10.00		30.00								12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.25	8.00		24.00					0.41	13.00		39.00								20.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	8	6	Select Care Drugs	1	4	000010	1	2		110	01	100		1				30		90	1			90				30		31									0.32	10.00		30.00					0.32	10.00		30.00								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4406	001	0	1	01	01	H4406_001_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4406	001	0	1	01	01	H4406_001_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					542.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4406	001	0	1	01	01	H4406_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4406	001	0	1	01	01	H4406_001_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4406	001	0	1	01	01	H4406_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	002	0	1	01	01	H4407_002_0	2	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4407	002	0	1	01	01	H4407_002_0	2	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					534.14	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	002	0	1	01	01	H4407_002_0	2	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00		245.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	002	0	1	01	01	H4407_002_0	2	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	002	0	1	01	01	H4407_002_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	002	0	1	01	01	H4407_002_0	2	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4407	002	0	1	01	01	H4407_002_0	2	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	022	0	1	02	01	H4407_022_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	022	0	1	02	01	H4407_022_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	022	0	1	02	01	H4407_022_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	022	0	1	02	01	H4407_022_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					416.40	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	022	0	1	02	01	H4407_022_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4407	022	0	1	02	01	H4407_022_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4407	022	0	1	02	01	H4407_022_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	001	0	1	04	01	H4408_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	001	0	1	04	01	H4408_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	001	0	1	04	01	H4408_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	001	0	1	04	01	H4408_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	001	0	1	04	01	H4408_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	001	0	1	04	01	H4408_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4408	001	0	1	04	01	H4408_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4408	001	0	1	04	01	H4408_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	001	0	1	04	01	H4408_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	001	0	1	04	01	H4408_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	002	0	1	04	01	H4408_002_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	002	0	1	04	01	H4408_002_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	002	0	1	04	01	H4408_002_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	002	0	1	04	01	H4408_002_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4408	002	0	1	04	01	H4408_002_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	002	0	1	04	01	H4408_002_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	002	0	1	04	01	H4408_002_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	002	0	1	04	01	H4408_002_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	002	0	1	04	01	H4408_002_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	002	0	1	04	01	H4408_002_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4408	006	0	1	04	01	H4408_006_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	006	0	1	04	01	H4408_006_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	006	0	1	04	01	H4408_006_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	006	0	1	04	01	H4408_006_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	006	0	1	04	01	H4408_006_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	006	0	1	04	01	H4408_006_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	006	0	1	04	01	H4408_006_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	006	0	1	04	01	H4408_006_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	006	0	1	04	01	H4408_006_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4408	006	0	1	04	01	H4408_006_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4408	007	0	1	04	01	H4408_007_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	007	0	1	04	01	H4408_007_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	007	0	1	04	01	H4408_007_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	007	0	1	04	01	H4408_007_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	007	0	1	04	01	H4408_007_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	007	0	1	04	01	H4408_007_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4408	007	0	1	04	01	H4408_007_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4408	007	0	1	04	01	H4408_007_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	007	0	1	04	01	H4408_007_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	007	0	1	04	01	H4408_007_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	008	0	1	04	01	H4408_008_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	008	0	1	04	01	H4408_008_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	008	0	1	04	01	H4408_008_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4408	008	0	1	04	01	H4408_008_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4408	008	0	1	04	01	H4408_008_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	008	0	1	04	01	H4408_008_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4408	008	0	1	04	01	H4408_008_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	008	0	1	04	01	H4408_008_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	008	0	1	04	01	H4408_008_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4408	008	0	1	04	01	H4408_008_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4454	002	0	1	01	01	H4454_002_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	002	0	1	01	01	H4454_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	002	0	1	01	01	H4454_002_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	002	0	1	01	01	H4454_002_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	002	0	1	01	01	H4454_002_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					484.67	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	002	0	1	01	01	H4454_002_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	002	0	1	01	01	H4454_002_0	4	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	030	0	1	02	01	H4454_030_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	030	0	1	02	01	H4454_030_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	030	0	1	02	01	H4454_030_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					568.47	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					467.13	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00		6.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00		6.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	031	0	1	01	01	H4454_031_0	4	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	032	0	1	02	01	H4454_032_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	032	0	1	02	01	H4454_032_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	032	0	1	02	01	H4454_032_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	032	0	1	02	01	H4454_032_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	032	0	1	02	01	H4454_032_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					478.49	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	032	0	1	02	01	H4454_032_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	032	0	1	02	01	H4454_032_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4456	010	0	1	01	01	H4456_010_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					570.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	010	0	1	01	01	H4456_010_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	010	0	1	01	01	H4456_010_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	010	0	1	01	01	H4456_010_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	010	0	1	01	01	H4456_010_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	013	0	1	01	01	H4456_013_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	013	0	1	01	01	H4456_013_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	013	0	1	01	01	H4456_013_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	013	0	1	01	01	H4456_013_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	013	0	1	01	01	H4456_013_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					625.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	015	0	1	01	01	H4456_015_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					659.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	015	0	1	01	01	H4456_015_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	015	0	1	01	01	H4456_015_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.23	7.00		21.00																															14.00							21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	015	0	1	01	01	H4456_015_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.26	38.00		114.00																															104.00							114.00				38.00				1.22	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	015	0	1	01	01	H4456_015_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	2.83	85.00		255.00																															245.00							255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	021	0	1	01	01	H4456_021_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					565.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	021	0	1	01	01	H4456_021_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.46	44.00		132.00																															122.00							132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	021	0	1	01	01	H4456_021_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.20	6.00		18.00																															0.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	021	0	1	01	01	H4456_021_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															0.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	021	0	1	01	01	H4456_021_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.03	91.00		273.00																															263.00							273.00				91.00				2.93	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	025	0	1	01	01	H4456_025_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					496.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	025	0	1	01	01	H4456_025_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	025	0	1	01	01	H4456_025_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.46	44.00		132.00																															122.00							132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	025	0	1	01	01	H4456_025_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4456	025	0	1	01	01	H4456_025_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	001	0	1	01	01	H4461_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	001	0	1	01	01	H4461_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4461	001	0	1	01	01	H4461_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	001	0	1	01	01	H4461_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	001	0	1	01	01	H4461_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	001	0	1	01	01	H4461_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	001	0	1	01	01	H4461_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	001	0	1	01	01	H4461_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	001	0	1	01	01	H4461_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	001	0	1	01	01	H4461_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	015	0	1	01	01	H4461_015_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4461	015	0	1	01	01	H4461_015_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	015	0	1	01	01	H4461_015_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	015	0	1	01	01	H4461_015_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	015	0	1	01	01	H4461_015_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	015	0	1	01	01	H4461_015_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	015	0	1	01	01	H4461_015_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	015	0	1	01	01	H4461_015_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	015	0	1	01	01	H4461_015_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	015	0	1	01	01	H4461_015_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	018	0	1	01	01	H4461_018_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4461	018	0	1	01	01	H4461_018_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	018	0	1	01	01	H4461_018_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	018	0	1	01	01	H4461_018_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	018	0	1	01	01	H4461_018_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	018	0	1	01	01	H4461_018_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	018	0	1	01	01	H4461_018_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	018	0	1	01	01	H4461_018_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	018	0	1	01	01	H4461_018_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	018	0	1	01	01	H4461_018_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	025	0	1	01	01	H4461_025_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	025	0	1	01	01	H4461_025_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	025	0	1	01	01	H4461_025_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	025	0	1	01	01	H4461_025_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4461	025	0	1	01	01	H4461_025_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.06	2.00		6.00																												0.06	2.00		0.00				0.06	2.00		6.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	029	0	1	01	01	H4461_029_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.06	2.00		6.00																												0.06	2.00		0.00				0.06	2.00		6.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4461	029	0	1	01	01	H4461_029_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	029	0	1	01	01	H4461_029_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	029	0	1	01	01	H4461_029_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	029	0	1	01	01	H4461_029_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	8	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	8	3	Preferred Brand	3	4	000001	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4506	003	0	1	01	01	H4506_003_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4506	003	0	1	01	01	H4506_003_0	8	1	Preferred Generic	3	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4506	003	0	1	01	01	H4506_003_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	8	3	Preferred Brand	1	4	000001	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	8	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4506	029	0	1	02	01	H4506_029_0	8	1	Preferred Generic	3	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4506	029	0	1	02	01	H4506_029_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	8	3	Preferred Brand	1	4	000001	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	8	3	Preferred Brand	3	4	000001	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4510	012	0	1	01	01	H4510_012_0	5	4	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	012	0	1	01	01	H4510_012_0	5	3	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	012	0	1	01	01	H4510_012_0	5	2	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	012	0	1	01	01	H4510_012_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	012	0	1	01	01	H4510_012_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4510	012	0	1	01	01	H4510_012_0	5	2	Preferred Brand	3	4	010001	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	012	0	1	01	01	H4510_012_0	5	3	Non-Preferred Brand	3	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	012	0	1	01	01	H4510_012_0	5	4	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	015	0	1	01	01	H4510_015_0	5	4	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	015	0	1	01	01	H4510_015_0	5	3	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	015	0	1	01	01	H4510_015_0	5	2	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	015	0	1	01	01	H4510_015_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	015	0	1	01	01	H4510_015_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4510	015	0	1	01	01	H4510_015_0	5	4	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	015	0	1	01	01	H4510_015_0	5	3	Non-Preferred Brand	3	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	015	0	1	01	01	H4510_015_0	5	2	Preferred Brand	3	4	010001	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	018	0	1	01	01	H4510_018_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	018	0	1	01	01	H4510_018_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	018	0	1	01	01	H4510_018_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	018	0	1	01	01	H4510_018_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	018	0	1	01	01	H4510_018_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	018	0	1	01	01	H4510_018_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4510	018	0	1	01	01	H4510_018_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	018	0	1	01	01	H4510_018_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	018	0	1	01	01	H4510_018_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4510	018	0	1	01	01	H4510_018_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	022	0	1	01	01	H4510_022_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	022	0	1	01	01	H4510_022_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	022	0	1	01	01	H4510_022_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	022	0	1	01	01	H4510_022_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	022	0	1	01	01	H4510_022_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	022	0	1	01	01	H4510_022_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4510	022	0	1	01	01	H4510_022_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4510	022	0	1	01	01	H4510_022_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	022	0	1	01	01	H4510_022_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.66	80.00		240.00																												2.66	80.00		230.00				2.66	80.00		240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	022	0	1	01	01	H4510_022_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	027	0	1	01	01	H4510_027_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	027	0	1	01	01	H4510_027_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	027	0	1	01	01	H4510_027_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	027	0	1	01	01	H4510_027_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	027	0	1	01	01	H4510_027_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.40	42.00		126.00																												1.40	42.00		116.00				1.40	42.00		126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	027	0	1	01	01	H4510_027_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4510	027	0	1	01	01	H4510_027_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4510	027	0	1	01	01	H4510_027_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	027	0	1	01	01	H4510_027_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	027	0	1	01	01	H4510_027_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.40	42.00		126.00																												1.40	42.00		116.00				1.40	42.00		126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	028	0	1	01	01	H4510_028_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	028	0	1	01	01	H4510_028_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	028	0	1	01	01	H4510_028_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	028	0	1	01	01	H4510_028_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	028	0	1	01	01	H4510_028_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	028	0	1	01	01	H4510_028_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4510	028	0	1	01	01	H4510_028_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4510	028	0	1	01	01	H4510_028_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	028	0	1	01	01	H4510_028_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	028	0	1	01	01	H4510_028_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	029	0	1	01	01	H4510_029_0	6	3	Non-Preferred Brand	3	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	029	0	1	01	01	H4510_029_0	6	4	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	029	0	1	01	01	H4510_029_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	029	0	1	01	01	H4510_029_0	6	2	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	029	0	1	01	01	H4510_029_0	6	3	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	029	0	1	01	01	H4510_029_0	6	4	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	029	0	1	01	01	H4510_029_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4510	029	0	1	01	01	H4510_029_0	6	2	Preferred Brand	3	4	010001	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	030	0	1	01	01	H4510_030_0	6	2	Preferred Brand	3	4	010001	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	030	0	1	01	01	H4510_030_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4510	030	0	1	01	01	H4510_030_0	6	4	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	030	0	1	01	01	H4510_030_0	6	3	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	030	0	1	01	01	H4510_030_0	6	2	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		50.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	030	0	1	01	01	H4510_030_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	030	0	1	01	01	H4510_030_0	6	3	Non-Preferred Brand	3	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00	60.00		180.00																												2.00	60.00		170.00				2.00	60.00		180.00				60.00				1.93	60.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	030	0	1	01	01	H4510_030_0	6	4	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	032	0	1	01	01	H4510_032_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.03	1.00		3.00																												0.03	1.00		0.00				0.03	1.00		3.00				1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4510	032	0	1	01	01	H4510_032_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	032	0	1	01	01	H4510_032_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	032	0	1	01	01	H4510_032_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	032	0	1	01	01	H4510_032_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	032	0	1	01	01	H4510_032_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.03	1.00		3.00																												0.03	1.00		0.00				0.03	1.00		3.00				1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4510	032	0	1	01	01	H4510_032_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4510	032	0	1	01	01	H4510_032_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	032	0	1	01	01	H4510_032_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4510	032	0	1	01	01	H4510_032_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4513	001	0	1	01	01	H4513_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.13	4.00	8.00	12.00																					0.13	4.00		3.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	001	0	1	01	01	H4513_001_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.00	30.00	60.00	90.00																					1.00	30.00		80.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	001	0	1	01	01	H4513_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.00	60.00	120.00	180.00																					2.00	60.00		170.00																		60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	001	0	1	01	01	H4513_001_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	001	0	1	01	01	H4513_001_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4513	001	0	1	01	01	H4513_001_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					578.08	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	001	0	1	01	01	H4513_001_0	4	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.13	4.00	8.00	12.00																					0.13	4.00		3.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4514	007	0	1	01	01	H4514_007_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					631.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4520	006	0	1	04	01	H4520_006_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.76	83.00		249.00																												2.76	83.00		239.00				2.76	83.00		249.00				83.00				2.67	83.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4520	006	0	1	04	01	H4520_006_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.40	42.00		126.00																												1.40	42.00		116.00				1.40	42.00		126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4520	006	0	1	04	01	H4520_006_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4520	006	0	1	04	01	H4520_006_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4520	006	0	1	04	01	H4520_006_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4520	006	0	1	04	01	H4520_006_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4520	006	0	1	04	01	H4520_006_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4520	006	0	1	04	01	H4520_006_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.40	42.00		126.00																												1.40	42.00		116.00				1.40	42.00		126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4520	006	0	1	04	01	H4520_006_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.76	83.00		249.00																												2.76	83.00		239.00				2.76	83.00		249.00				83.00				2.67	83.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4520	006	0	1	04	01	H4520_006_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4520	022	0	1	04	01	H4520_022_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4520	022	0	1	04	01	H4520_022_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	26																														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4520	022	0	1	04	01	H4520_022_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4520	022	0	1	04	01	H4520_022_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.40	42.00		126.00																												1.40	42.00		116.00				1.40	42.00		126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4520	022	0	1	04	01	H4520_022_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4522	001	0	1	04	01	H4522_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4522	001	0	1	04	01	H4522_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					698.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4522	001	0	1	04	01	H4522_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4522	001	0	1	04	01	H4522_001_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4522	001	0	1	04	01	H4522_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4522	001	0	1	04	01	H4522_001_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4523	001	0	1	01	01	H4523_001_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	001	0	1	01	01	H4523_001_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					83.56	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	001	0	1	01	01	H4523_001_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					39.36	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	001	0	1	01	01	H4523_001_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	001	0	1	01	01	H4523_001_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	001	0	1	01	01	H4523_001_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4523	005	0	1	01	01	H4523_005_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	005	0	1	01	01	H4523_005_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	005	0	1	01	01	H4523_005_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					82.76	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	005	0	1	01	01	H4523_005_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					34.05	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	005	0	1	01	01	H4523_005_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	005	0	1	01	01	H4523_005_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4523	015	0	1	01	01	H4523_015_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	015	0	1	01	01	H4523_015_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	015	0	1	01	01	H4523_015_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					77.39	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	015	0	1	01	01	H4523_015_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.47	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	015	0	1	01	01	H4523_015_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	015	0	1	01	01	H4523_015_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4523	016	0	1	01	01	H4523_016_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	016	0	1	01	01	H4523_016_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					34.99	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	016	0	1	01	01	H4523_016_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.52	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	016	0	1	01	01	H4523_016_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	016	0	1	01	01	H4523_016_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	016	0	1	01	01	H4523_016_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4523	017	0	1	01	01	H4523_017_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	017	0	1	01	01	H4523_017_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					34.99	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	017	0	1	01	01	H4523_017_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.53	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	017	0	1	01	01	H4523_017_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	017	0	1	01	01	H4523_017_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	017	0	1	01	01	H4523_017_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4523	018	0	1	01	01	H4523_018_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					34.99	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	018	0	1	01	01	H4523_018_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.52	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	018	0	1	01	01	H4523_018_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	018	0	1	01	01	H4523_018_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	018	0	1	01	01	H4523_018_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4523	018	0	1	01	01	H4523_018_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	019	0	1	01	01	H4523_019_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					34.99	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	019	0	1	01	01	H4523_019_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.52	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	019	0	1	01	01	H4523_019_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	019	0	1	01	01	H4523_019_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4523	019	0	1	01	01	H4523_019_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4523	019	0	1	01	01	H4523_019_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	001	0	1	04	01	H4524_001_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4524	001	0	1	04	01	H4524_001_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	001	0	1	04	01	H4524_001_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	001	0	1	04	01	H4524_001_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					84.37	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	001	0	1	04	01	H4524_001_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	001	0	1	04	01	H4524_001_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					38.05	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	007	0	1	04	01	H4524_007_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	007	0	1	04	01	H4524_007_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					32.84	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	007	0	1	04	01	H4524_007_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					87.15	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	007	0	1	04	01	H4524_007_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	007	0	1	04	01	H4524_007_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4524	007	0	1	04	01	H4524_007_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	013	0	1	04	01	H4524_013_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4524	013	0	1	04	01	H4524_013_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	013	0	1	04	01	H4524_013_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					89.10	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	013	0	1	04	01	H4524_013_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					39.06	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	013	0	1	04	01	H4524_013_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4524	013	0	1	04	01	H4524_013_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4525	001	0	1	01	01	H4525_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	.32	10.00	20.00	30.00																					.32	10.00	20.00	25.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H4525	001	0	1	01	01	H4525_001_0	7	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	112.50																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H4525	001	0	1	01	01	H4525_001_0	7	4	Specialty Tier	1	4	100000	1	1	111		10	111		1	31	62	90				2	31	62	90					10	31					627.00	33	33	33																					33	33	33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H4525	001	0	1	01	01	H4525_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	.13	4.00	8.00	12.00																					.13	4.00	8.00	10.00																			4.00			.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H4525	002	0	1	01	01	H4525_002_0	7	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	.13	4.00	8.00	12.00																					.13	4.00	8.00	10.00																			4.00			.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H4525	002	0	1	01	01	H4525_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	.32	10.00	20.00	30.00																					.32	10.00	20.00	25.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H4525	002	0	1	01	01	H4525_002_0	7	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	112.50																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H4525	002	0	1	01	01	H4525_002_0	7	4	Specialty Tier	1	4	100000	1	1	111		10	111		1	31	62	90				2	31	62	90					10	31					627.00	33	33	33																					33	33	33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H4525	010	0	1	01	01	H4525_010_0	7	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	.13	4.00	8.00	12.00																					.13	4.00	8.00	10.00																			4.00			.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H4525	010	0	1	01	01	H4525_010_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	.32	10.00	20.00	30.00																					.32	10.00	20.00	25.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H4525	010	0	1	01	01	H4525_010_0	7	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	112.50																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H4525	010	0	1	01	01	H4525_010_0	7	4	Specialty Tier	1	4	100000	1	1	111		10	111		1	31	62	90				2	31	62	90					10	31					627.00	33	33	33																					33	33	33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4527	001	0	1	01	01	H4527_001_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.33	10.00		30.00																															20.00							30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4527	001	0	1	01	01	H4527_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					793.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.00	90.00		270.00																															260.00							270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.00	30.00		90.00																															75.00							90.00				30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.33	10.00		30.00																															20.00							30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.33	10.00		30.00																															20.00							30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.33	10.00		30.00																															20.00							30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4527	002	0	1	01	01	H4527_002_0	6	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4527	002	0	1	01	01	H4527_002_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					688.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					582.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	6	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4527	005	0	1	01	01	H4527_005_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4527	005	0	1	01	01	H4527_005_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.33	10.00		30.00																															20.00							30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					695.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4527	013	0	1	01	01	H4527_013_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.33	10.00		30.00																															20.00							30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4528	001	0	1	01	01	H4528_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.26	8.00	16.00	24.00																					0.26	8.00		15.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00		95.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.33	70.00	140.00	210.00																					2.33	70.00		200.00																		70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					595.79	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4528	014	0	1	01	01	H4528_014_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H4528	014	0	1	01	01	H4528_014_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.26	8.00	16.00	24.00																					0.26	8.00		15.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H4528	014	0	1	01	01	H4528_014_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00		95.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H4528	014	0	1	01	01	H4528_014_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.33	70.00	140.00	210.00																					2.33	70.00		200.00																		70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H4528	014	0	1	01	01	H4528_014_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					616.61	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H4528	014	0	1	01	01	H4528_014_0	4	6	Select Diabetic Drugs	1	4	010010	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00		5.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H4564	001	0	1	18	06	H4564_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.50	15.00	30.00	45.00					.50	15.00	30.00	45.00					.50	15.00	30.00	30.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.17	35.00	70.00	105.00					1.17	35.00	70.00	105.00					1.17	35.00	70.00	70.00																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.17	65.00	130.00	195.00					2.17	65.00	130.00	195.00					2.17	65.00	130.00	130.00																		65.00				1.91	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	8	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.50	15.00	30.00	45.00					.50	15.00	30.00	45.00					.50	15.00	30.00	30.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	4	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.17	35.00	70.00	105.00					1.17	35.00	70.00	105.00					1.17	35.00	70.00	70.00																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.17	65.00	130.00	195.00					2.17	65.00	130.00	195.00					2.17	65.00	130.00	130.00																		65.00				1.91	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	4	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	003	0	1	18	06	H4564_003_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	003	0	1	18	06	H4564_003_0	4	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	003	0	1	18	06	H4564_003_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.17	65.00	130.00	195.00					2.17	65.00	130.00	195.00					2.17	65.00	130.00	130.00																		65.00				1.91	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	003	0	1	18	06	H4564_003_0	4	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.17	35.00	70.00	105.00					1.17	35.00	70.00	105.00					1.17	35.00	70.00	70.00																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	003	0	1	18	06	H4564_003_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.50	15.00	30.00	45.00					.50	15.00	30.00	45.00					.50	15.00	30.00	30.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					0.07	2.00	4.00	6.00					.07	2.00	4.00	4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	6	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.17	65.00	130.00	195.00					2.17	65.00	130.00	195.00					2.17	65.00	130.00	130.00																		65.00				1.91	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.17	35.00	70.00	105.00					1.17	35.00	70.00	105.00					1.17	35.00	70.00	70.00																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.27	8.00	16.00	24.00					.27	8.00	16.00	24.00					.27	8.00	16.00	16.00																		8.00				.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.00	0.00	0.00	0.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4564	005	0	1	18	06	H4564_005_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.27	8.00	16.00	24.00					.27	8.00	16.00	24.00					.27	8.00	16.00	16.00																		8.00				.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					0.07	2.00	4.00	6.00					.07	2.00	4.00	4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.17	35.00	70.00	105.00					1.17	35.00	70.00	105.00					1.17	35.00	70.00	70.00																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4564	005	0	1	18	06	H4564_005_0	5	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.17	65.00	130.00	195.00					2.17	65.00	130.00	195.00					2.17	65.00	130.00	130.00																		65.00				1.91	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	006	0	1	18	06	H4564_006_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.17	65.00	130.00	195.00					2.17	65.00	130.00	195.00					2.17	65.00	130.00	130.00																		65.00				1.91	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	006	0	1	18	06	H4564_006_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.17	35.00	70.00	105.00					1.17	35.00	70.00	105.00					1.17	35.00	70.00	70.00																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	006	0	1	18	06	H4564_006_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.27	8.00	16.00	24.00					.27	8.00	16.00	24.00					.27	8.00	16.00	16.00																		8.00				.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	006	0	1	18	06	H4564_006_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					0.07	2.00	4.00	6.00					.07	2.00	4.00	4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	006	0	1	18	06	H4564_006_0	5	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	006	0	1	18	06	H4564_006_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4564	013	0	1	18	06	H4564_013_0	4	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.50	75.00	150.00	225.00					2.50	75.00	150.00	225.00					2.50	75.00	150.00	150.00																		75.00				2.21	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	013	0	1	18	06	H4564_013_0	4	3	Preferred Brand	1	3	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00					1.50	45.00	90.00	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	013	0	1	18	06	H4564_013_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.67	20.00	40.00	60.00					.67	20.00	40.00	60.00					.67	20.00	40.00	40.00																		20.00				.59	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	013	0	1	18	06	H4564_013_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.13	4.00	8.00	12.00					.20	6.00	12.00	18.00					.20	6.00	12.00	12.00																		6.00				.18	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	013	0	1	18	06	H4564_013_0	4	5	Specialty Tier	1	3	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	014	0	1	18	06	H4564_014_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.13	4.00	8.00	12.00					.20	6.00	12.00	18.00					.20	6.00	12.00	12.00																		6.00				.18	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	014	0	1	18	06	H4564_014_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.67	20.00	40.00	60.00					.67	20.00	40.00	60.00					.67	20.00	40.00	40.00																		20.00				.59	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	014	0	1	18	06	H4564_014_0	4	3	Preferred Brand	1	3	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00					1.50	45.00	90.00	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	014	0	1	18	06	H4564_014_0	4	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.50	75.00	150.00	225.00					2.50	75.00	150.00	225.00					2.50	75.00	150.00	150.00																		75.00				2.21	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	014	0	1	18	06	H4564_014_0	4	5	Specialty Tier	1	3	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.13	4.00	8.00	12.00					.20	6.00	12.00	18.00					.20	6.00	12.00	12.00																		6.00				.18	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	4	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.50	75.00	150.00	225.00					2.50	75.00	150.00	225.00					2.50	75.00	150.00	150.00																		75.00				2.21	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	4	3	Preferred Brand	1	3	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00					1.50	45.00	90.00	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.67	20.00	40.00	60.00					.67	20.00	40.00	60.00					.67	20.00	40.00	40.00																		20.00				.59	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	4	5	Specialty Tier	1	3	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.50	15.00	30.00	45.00					.50	15.00	30.00	45.00					.50	15.00	30.00	30.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	4	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.17	35.00	70.00	105.00					1.17	35.00	70.00	105.00					1.17	35.00	70.00	70.00																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.17	65.00	130.00	195.00					2.17	65.00	130.00	195.00					2.17	65.00	130.00	130.00																		65.00				1.91	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	4	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.27	8.00	16.00	24.00					.27	8.00	16.00	24.00					.27	8.00	16.00	16.00																		8.00				.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					0.07	2.00	4.00	6.00					.07	2.00	4.00	4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.17	35.00	70.00	105.00					1.17	35.00	70.00	105.00					1.17	35.00	70.00	70.00																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.17	65.00	130.00	195.00					2.17	65.00	130.00	195.00					2.17	65.00	130.00	130.00																		65.00				1.91	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	5	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4564	019	0	1	18	06	H4564_019_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.13	4.00	8.00	12.00					.20	6.00	12.00	18.00					.20	6.00	12.00	12.00																		6.00				.18	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	019	0	1	18	06	H4564_019_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.67	20.00	40.00	60.00					.67	20.00	40.00	60.00					.67	20.00	40.00	40.00																		20.00				.59	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	019	0	1	18	06	H4564_019_0	4	3	Preferred Brand	1	3	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00					1.50	45.00	90.00	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	019	0	1	18	06	H4564_019_0	4	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.50	75.00	150.00	225.00					2.50	75.00	150.00	225.00					2.50	75.00	150.00	150.00																		75.00				2.21	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	019	0	1	18	06	H4564_019_0	4	5	Specialty Tier	1	3	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	021	0	1	18	06	H4564_021_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.50	15.00	30.00	45.00					.50	15.00	30.00	45.00					.50	15.00	30.00	30.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	021	0	1	18	06	H4564_021_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	021	0	1	18	06	H4564_021_0	4	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.17	35.00	70.00	105.00					1.17	35.00	70.00	105.00					1.17	35.00	70.00	70.00																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	021	0	1	18	06	H4564_021_0	4	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	021	0	1	18	06	H4564_021_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.17	65.00	130.00	195.00					2.17	65.00	130.00	195.00					2.17	65.00	130.00	130.00																		65.00				1.91	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	022	0	1	18	06	H4564_022_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					0.07	2.00	4.00	6.00					.07	2.00	4.00	4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	022	0	1	18	06	H4564_022_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.27	8.00	16.00	24.00					.27	8.00	16.00	24.00					.27	8.00	16.00	16.00																		8.00				.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	022	0	1	18	06	H4564_022_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.17	35.00	70.00	105.00					1.17	35.00	70.00	105.00					1.17	35.00	70.00	70.00																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	022	0	1	18	06	H4564_022_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.17	65.00	130.00	195.00					2.17	65.00	130.00	195.00					2.17	65.00	130.00	130.00																		65.00				1.91	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	022	0	1	18	06	H4564_022_0	5	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	022	0	1	18	06	H4564_022_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									0.00	0.00	0.00	0.00					.13	4.00	8.00	12.00					.13	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4564	023	0	1	18	06	H4564_023_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.13	4.00	8.00	12.00					.20	6.00	12.00	18.00					.20	6.00	12.00	12.00																		6.00				.18	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	023	0	1	18	06	H4564_023_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									.67	20.00	40.00	60.00					.67	20.00	40.00	60.00					.67	20.00	40.00	40.00																		20.00				.59	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	023	0	1	18	06	H4564_023_0	4	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									2.50	75.00	150.00	225.00					2.50	75.00	150.00	225.00					2.50	75.00	150.00	150.00																		75.00				2.21	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	023	0	1	18	06	H4564_023_0	4	3	Preferred Brand	1	3	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00					1.50	45.00	90.00	90.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	023	0	1	18	06	H4564_023_0	4	5	Specialty Tier	1	3	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34														33	33	33						33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					597.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.43	43.00		129.00																															75.00							129.00				43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4590	010	0	1	01	01	H4590_010_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4590	012	0	1	01	01	H4590_012_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					672.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4590	012	0	1	01	01	H4590_012_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4590	025	0	1	01	01	H4590_025_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					506.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4590	037	0	1	01	01	H4590_037_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					658.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.43	43.00		129.00																															75.00							129.00				43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4590	037	0	1	01	01	H4590_037_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	5	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.30	9.00		27.00																															18.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	5	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	5	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					494.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	15	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					484.00	28																							28																			28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	15	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	15	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	15	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	15	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					572.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4605	004	0	1	04	01	H4605_004_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4606	001	0	1	04	01	H4606_001_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4606	001	0	1	04	01	H4606_001_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.40	42.00		126.00																												1.40	42.00		116.00				1.40	42.00		126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4606	001	0	1	04	01	H4606_001_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4606	001	0	1	04	01	H4606_001_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4606	001	0	1	04	01	H4606_001_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4606	001	0	1	04	01	H4606_001_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4606	001	0	1	04	01	H4606_001_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.40	42.00		126.00																												1.40	42.00		116.00				1.40	42.00		126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4606	001	0	1	04	01	H4606_001_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4606	001	0	1	04	01	H4606_001_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4606	001	0	1	04	01	H4606_001_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4738	002	0	1	04	01	H4738_002_0	5	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.13	4.00		12.00																					0.13	4.00		10.00																		4.00				0.12	4.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4738	002	0	1	04	01	H4738_002_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4738	002	0	1	04	01	H4738_002_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.83	85.00		255.00																					2.83	85.00		212.50																		85.00				2.74	85.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4738	002	0	1	04	01	H4738_002_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	001	0	1	04	01	H4754_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		93				2	31		93				31		31	0.32	10.00		30.00																					0.32	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	001	0	1	04	01	H4754_001_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	001	0	1	04	01	H4754_001_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		93				2	31		93				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	001	0	1	04	01	H4754_001_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		93				2	31		93				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	001	0	1	04	01	H4754_001_0	8	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	31							31						31		31					903.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	001	0	1	04	01	H4754_001_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4754	002	0	1	04	01	H4754_002_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	002	0	1	04	01	H4754_002_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		93				2	31		93				31		31	0.32	10.00		30.00																					0.32	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	002	0	1	04	01	H4754_002_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		93				2	31		93				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	002	0	1	04	01	H4754_002_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		93				2	31		93				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	002	0	1	04	01	H4754_002_0	8	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	31							31						31		31					903.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	002	0	1	04	01	H4754_002_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4754	004	0	1	04	01	H4754_004_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4754	004	0	1	04	01	H4754_004_0	9	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	31							31						31		31					903.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	004	0	1	04	01	H4754_004_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		93				2	31		93				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	004	0	1	04	01	H4754_004_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		93				2	31		93				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	004	0	1	04	01	H4754_004_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		93				2	31		93				31		31	0.32	10.00		30.00																					0.32	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	004	0	1	04	01	H4754_004_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	007	0	1	04	01	H4754_007_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		93				2	31		93				31		31	0.32	10.00		30.00																					0.32	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	007	0	1	04	01	H4754_007_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		93				2	31		93				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	007	0	1	04	01	H4754_007_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		93				2	31		93				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	007	0	1	04	01	H4754_007_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	31							31						31		31					903.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	007	0	1	04	01	H4754_007_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4754	007	0	1	04	01	H4754_007_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	009	0	1	04	01	H4754_009_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	009	0	1	04	01	H4754_009_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		93				2	31		93				31		31	0.32	10.00		30.00																					0.32	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	009	0	1	04	01	H4754_009_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		93				2	31		93				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	009	0	1	04	01	H4754_009_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		93				2	31		93				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	009	0	1	04	01	H4754_009_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4754	009	0	1	04	01	H4754_009_0	7	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	31							31						31		31					903.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	011	0	1	04	01	H4754_011_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	011	0	1	04	01	H4754_011_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		93				2	31		93				31		31	0.12	4.00		12.00																					0.12	4.00		12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4754	011	0	1	04	01	H4754_011_0	8	5	Specialty Tier	1	4	110001	1	1	010		01	010		1	31							31						31		31					903.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	011	0	1	04	01	H4754_011_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		93				2	31		93				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	011	0	1	04	01	H4754_011_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		93				2	31		93				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	011	0	1	04	01	H4754_011_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		93				2	31		93				31		31	0.32	10.00		30.00																					0.32	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4866	003	0	1	01	01	H4866_003_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.17	35.00		105.00																								52.50																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4866	003	0	1	01	01	H4866_003_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.20	6.00		18.00																								9.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4866	003	0	1	01	01	H4866_003_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.10	3.00		9.00																								4.50																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4866	003	0	1	01	01	H4866_003_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31						30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4866	003	0	1	01	01	H4866_003_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.50	75.00		225.00																								112.50																		75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4871	001	0	1	04	01	H4871_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.23	7.00	14.00	21.00																					0.23	7.00		12.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4871	001	0	1	04	01	H4871_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4871	001	0	1	04	01	H4871_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.33	40.00	80.00	120.00																					1.33	40.00		110.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4871	001	0	1	04	01	H4871_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.36	11.00	22.00	33.00																					0.36	11.00		24.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4871	001	0	1	04	01	H4871_001_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					596.19	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	9	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					0.32	10.00		25.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					312.18	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	9	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.90	90.00		270.00																					2.90	90.00		225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	9	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					312.18	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	8	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					0.32	10.00		25.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	8	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.90	90.00		270.00																					2.90	90.00		225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	9	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					0.32	10.00		25.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	9	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					312.18	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	9	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.90	90.00		270.00																					2.90	90.00		225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					312.18	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	8	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.90	90.00		270.00																					2.90	90.00		225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	8	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					0.32	10.00		25.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	8	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.90	90.00		270.00																					2.90	90.00		225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					312.18	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	8	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					0.32	10.00		25.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	8	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.25	8.00		24.00																					0.25	8.00		20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	8	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.74	85.00		255.00																					2.74	85.00		212.50																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					312.18	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		120.00																					1.29	40.00		100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	8	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.25	8.00		24.00																					0.25	8.00		20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		120.00																					1.29	40.00		100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	8	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.74	85.00		255.00																					2.74	85.00		212.50																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					312.18	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					312.18	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	8	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.74	85.00		255.00																					2.74	85.00		212.50																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	8	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.25	8.00		24.00																					0.25	8.00		20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		120.00																					1.29	40.00		100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	9	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.25	8.00		24.00																					0.25	8.00		20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	9	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		120.00																					1.29	40.00		100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	9	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.74	85.00		255.00																					2.74	85.00		212.50																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					312.18	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	9	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		120.00																					1.29	40.00		100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	9	1	Generic	1	4	010010	1	2	110		01	110		1	31		90				1	31		90				31		31	0.25	8.00		24.00																					0.25	8.00		20.00																		8.00				0.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					312.18	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	9	3	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.74	85.00		255.00																					2.74	85.00		212.50																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	7	3	Non-Preferred Brand	1	4	100000	3	2	111		01	111		1	31	62	90				1	31	62	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	7	1	Generic	3	4	010000	1	2	111		01	111		1	31	62	90				1	31	62	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4876	001	0	1	04	01	H4876_001_0	7	1	Generic	1	4	010000	1	2	111		01	111		1	31	62	90				1	31	62	90				31		31	.16	5.00	10.00	15.00																					.16	5.00	10.00	15.00																		5.00				.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	7	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	90				1	31	62	90				31		31	.80	25.00	50.00	75.00																					.80	25.00	50.00	75.00																		25.00				.80	25.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	7	4	Specialty Tier	1	4	100000	1	1	111		01	111		1	31	62	90				1	31	62	90				31		31					100.00	33	33	33																					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4909	009	0	1	04	01	H4909_009_0	9	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4909	009	0	1	04	01	H4909_009_0	9	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													74.00	33	33	33					74.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4909	009	0	1	04	01	H4909_009_0	9	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4909	009	0	1	04	01	H4909_009_0	9	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4909	009	0	1	04	01	H4909_009_0	9	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.44	15.00	30.00	45.00					.59	20.00	40.00	60.00					.44	15.00	30.00	30.00																		20.00				.59	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4909	009	0	1	04	01	H4909_009_0	9	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4909	010	0	1	04	01	H4909_010_0	8	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													74.00	33	33	33					74.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4909	010	0	1	04	01	H4909_010_0	8	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4909	010	0	1	04	01	H4909_010_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4909	010	0	1	04	01	H4909_010_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4909	010	0	1	04	01	H4909_010_0	8	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.50	17.00	34.00	51.00					.65	22.00	44.00	66.00					.50	17.00	34.00	34.00																		22.00				.65	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4909	010	0	1	04	01	H4909_010_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4910	005	0	1	01	01	H4910_005_0	6	3	Non-Preferred Brand	1	3	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4910	005	0	1	01	01	H4910_005_0	6	2	Preferred Brand	1	3	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.40	42.00	84.00	126.00																												1.40	42.00	84.00	84.00				1.40	42.00	84.00	126.00					42.00			1.35	42.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4910	005	0	1	01	01	H4910_005_0	6	1	Generic	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4910	005	0	1	01	01	H4910_005_0	6	4	Specialty Tier	1	3	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4910	005	0	1	01	01	H4910_005_0	6	5	Select Care Drugs	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4910	006	0	1	01	01	H4910_006_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4910	006	0	1	01	01	H4910_006_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4910	006	0	1	01	01	H4910_006_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4910	006	0	1	01	01	H4910_006_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4910	006	0	1	01	01	H4910_006_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4910	006	0	1	01	01	H4910_006_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4956	001	0	1	04	01	H4956_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	001	0	1	04	01	H4956_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	001	0	1	04	01	H4956_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	001	0	1	04	01	H4956_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	001	0	1	04	01	H4956_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4956	001	0	1	04	01	H4956_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4956	001	0	1	04	01	H4956_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4956	001	0	1	04	01	H4956_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4956	001	0	1	04	01	H4956_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4956	001	0	1	04	01	H4956_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	002	0	1	04	01	H4956_002_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	002	0	1	04	01	H4956_002_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	002	0	1	04	01	H4956_002_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4956	002	0	1	04	01	H4956_002_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4956	002	0	1	04	01	H4956_002_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4956	002	0	1	04	01	H4956_002_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4956	002	0	1	04	01	H4956_002_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4956	002	0	1	04	01	H4956_002_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	002	0	1	04	01	H4956_002_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	002	0	1	04	01	H4956_002_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	003	0	1	04	01	H4956_003_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	003	0	1	04	01	H4956_003_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	003	0	1	04	01	H4956_003_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	003	0	1	04	01	H4956_003_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H4956	003	0	1	04	01	H4956_003_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4956	003	0	1	04	01	H4956_003_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4956	003	0	1	04	01	H4956_003_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4956	003	0	1	04	01	H4956_003_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	003	0	1	04	01	H4956_003_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4956	003	0	1	04	01	H4956_003_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5005	011	0	1	01	01	H5005_011_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	011	0	1	01	01	H5005_011_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.20	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	011	0	1	01	01	H5005_011_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.46	44.00		132.00																															122.00							132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	011	0	1	01	01	H5005_011_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	2.93	88.00		264.00																															254.00							264.00				88.00				2.83	88.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	011	0	1	01	01	H5005_011_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					467.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	011	0	1	01	01	H5005_011_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5005	011	0	1	01	01	H5005_011_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.20	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5005	019	0	1	01	01	H5005_019_0	7	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	019	0	1	01	01	H5005_019_0	7	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	019	0	1	01	01	H5005_019_0	7	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					554.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	019	0	1	01	01	H5005_019_0	7	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5005	019	0	1	01	01	H5005_019_0	7	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.23	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	12	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.23	7.00		21.00																					.23	7.00		14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	12	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	12	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	12	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	12	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					488.00	26																							26																			26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	14	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					571.00	27																							27																			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	14	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	14	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	14	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	14	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.23	7.00		21.00																					.23	7.00		14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_0	13	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					560.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_0	13	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_0	13	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_0	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_0	13	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5010	004	0	1	04	01	H5010_004_0	13	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	001	0	1	04	01	H5041_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	001	0	1	04	01	H5041_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	001	0	1	04	01	H5041_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	001	0	1	04	01	H5041_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	001	0	1	04	01	H5041_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	001	0	1	04	01	H5041_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5041	001	0	1	04	01	H5041_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5041	001	0	1	04	01	H5041_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	001	0	1	04	01	H5041_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	001	0	1	04	01	H5041_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	002	0	1	04	01	H5041_002_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	002	0	1	04	01	H5041_002_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		6.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	002	0	1	04	01	H5041_002_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		15.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	002	0	1	04	01	H5041_002_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	002	0	1	04	01	H5041_002_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	002	0	1	04	01	H5041_002_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	002	0	1	04	01	H5041_002_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		6.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5041	002	0	1	04	01	H5041_002_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		15.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5041	002	0	1	04	01	H5041_002_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	002	0	1	04	01	H5041_002_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	006	0	1	04	01	H5041_006_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	006	0	1	04	01	H5041_006_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	006	0	1	04	01	H5041_006_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	006	0	1	04	01	H5041_006_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	006	0	1	04	01	H5041_006_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	006	0	1	04	01	H5041_006_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5041	006	0	1	04	01	H5041_006_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5041	006	0	1	04	01	H5041_006_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	006	0	1	04	01	H5041_006_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	006	0	1	04	01	H5041_006_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	007	0	1	04	01	H5041_007_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	007	0	1	04	01	H5041_007_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	007	0	1	04	01	H5041_007_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	007	0	1	04	01	H5041_007_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5041	007	0	1	04	01	H5041_007_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	007	0	1	04	01	H5041_007_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	007	0	1	04	01	H5041_007_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	007	0	1	04	01	H5041_007_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	007	0	1	04	01	H5041_007_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	007	0	1	04	01	H5041_007_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5041	008	0	1	04	01	H5041_008_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	008	0	1	04	01	H5041_008_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	008	0	1	04	01	H5041_008_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	008	0	1	04	01	H5041_008_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	008	0	1	04	01	H5041_008_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	008	0	1	04	01	H5041_008_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	008	0	1	04	01	H5041_008_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	008	0	1	04	01	H5041_008_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	008	0	1	04	01	H5041_008_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5041	008	0	1	04	01	H5041_008_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5041	009	0	1	04	01	H5041_009_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	009	0	1	04	01	H5041_009_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	009	0	1	04	01	H5041_009_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	009	0	1	04	01	H5041_009_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	009	0	1	04	01	H5041_009_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	009	0	1	04	01	H5041_009_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5041	009	0	1	04	01	H5041_009_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5041	009	0	1	04	01	H5041_009_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	009	0	1	04	01	H5041_009_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	009	0	1	04	01	H5041_009_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	012	0	1	04	01	H5041_012_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	012	0	1	04	01	H5041_012_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	012	0	1	04	01	H5041_012_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5041	012	0	1	04	01	H5041_012_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5041	012	0	1	04	01	H5041_012_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	012	0	1	04	01	H5041_012_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	012	0	1	04	01	H5041_012_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	012	0	1	04	01	H5041_012_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	012	0	1	04	01	H5041_012_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	012	0	1	04	01	H5041_012_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	013	0	1	04	01	H5041_013_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	013	0	1	04	01	H5041_013_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	013	0	1	04	01	H5041_013_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	013	0	1	04	01	H5041_013_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	013	0	1	04	01	H5041_013_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	013	0	1	04	01	H5041_013_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5041	013	0	1	04	01	H5041_013_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5041	013	0	1	04	01	H5041_013_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	013	0	1	04	01	H5041_013_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	013	0	1	04	01	H5041_013_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	015	0	1	04	01	H5041_015_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	015	0	1	04	01	H5041_015_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		0.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	015	0	1	04	01	H5041_015_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	015	0	1	04	01	H5041_015_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	015	0	1	04	01	H5041_015_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	015	0	1	04	01	H5041_015_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		0.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5041	015	0	1	04	01	H5041_015_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5041	015	0	1	04	01	H5041_015_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	015	0	1	04	01	H5041_015_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	015	0	1	04	01	H5041_015_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	016	0	1	04	01	H5041_016_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	016	0	1	04	01	H5041_016_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	016	0	1	04	01	H5041_016_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	016	0	1	04	01	H5041_016_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5041	016	0	1	04	01	H5041_016_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5041	016	0	1	04	01	H5041_016_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	016	0	1	04	01	H5041_016_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	016	0	1	04	01	H5041_016_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	016	0	1	04	01	H5041_016_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5041	016	0	1	04	01	H5041_016_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5042	001	0	1	04	01	H5042_001_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					796.19	30																							30																			30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	001	0	1	04	01	H5042_001_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5042	001	0	1	04	01	H5042_001_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5042	001	0	1	04	01	H5042_001_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	001	0	1	04	01	H5042_001_0	8	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.33	40.00		120.00																					1.33	40.00		80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	001	0	1	04	01	H5042_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	001	0	1	04	01	H5042_001_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	005	0	1	04	01	H5042_005_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	005	0	1	04	01	H5042_005_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					989.86	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	005	0	1	04	01	H5042_005_0	8	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	005	0	1	04	01	H5042_005_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.40	12.00		36.00																					0.40	12.00		24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	005	0	1	04	01	H5042_005_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	007	0	1	04	01	H5042_007_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					923.79	30																							30																			30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	007	0	1	04	01	H5042_007_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	007	0	1	04	01	H5042_007_0	6	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.33	40.00		120.00																					1.33	40.00		80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	007	0	1	04	01	H5042_007_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.26	8.00		24.00																					0.26	8.00		16.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	007	0	1	04	01	H5042_007_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5042	007	0	1	04	01	H5042_007_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5042	007	0	1	04	01	H5042_007_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.26	8.00		24.00																					0.26	8.00		16.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5048	001	0	1	01	01	H5048_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	001	0	1	01	01	H5048_001_0	7	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.10	3.00	6.00	9.00					.33	10.00	20.00	30.00					.10	3.00	3.00	3.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5048	001	0	1	01	01	H5048_001_0	7	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5048	001	0	1	01	01	H5048_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	001	0	1	01	01	H5048_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.33	70.00	140.00	140.00					3.16	95.00	190.00	190.00					2.33	70.00	140.00	140.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	001	0	1	01	01	H5048_001_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	70.00					1.50	45.00	90.00	90.00					1.16	35.00	70.00	70.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	001	0	1	01	01	H5048_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00					0.10	3.00	3.00	3.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	002	0	1	01	01	H5048_002_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	002	0	1	01	01	H5048_002_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	002	0	1	01	01	H5048_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00					.10	3.00	3.00	3.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	002	0	1	01	01	H5048_002_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	70.00					1.50	45.00	90.00	90.00					1.16	35.00	70.00	70.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	002	0	1	01	01	H5048_002_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.33	70.00	140.00	140.00					3.16	95.00	190.00	190.00					2.33	70.00	140.00	140.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5048	002	0	1	01	01	H5048_002_0	7	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00					0.10	3.00	3.00	3.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5048	002	0	1	01	01	H5048_002_0	7	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5050	004	0	1	01	01	H5050_004_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.76	25.00	50.00	75.00																					0.76	25.00	50.00	75.00																		25.00				0.76	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	004	0	1	01	01	H5050_004_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.32	20.00	40.00	60.00																					0.32	20.00	40.00	60.00																		20.00				0.32	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	004	0	1	01	01	H5050_004_0	7	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					75.30	50	50	50																					50	50	50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	004	0	1	01	01	H5050_004_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.12	4.00	8.00	12.00																					0.12	4.00	8.00	12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	009	0	1	01	01	H5050_009_0	6	2	Non-Preferred Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.29	15.00	30.00	45.00																					0.29	15.00	30.00	45.00																		15.00				0.29	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	009	0	1	01	01	H5050_009_0	6	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.12	4.00	8.00	12.00																					0.12	4.00	8.00	12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	009	0	1	01	01	H5050_009_0	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.68	22.00	44.00	66.00																					0.68	22.00	44.00	66.00																		22.00				0.68	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	009	0	1	01	01	H5050_009_0	6	4	Non-Preferred Brand	1	3	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					84.00	50	50	50																					50	50	50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	013	0	1	01	01	H5050_013_0	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.64	20.00	40.00	60.00																					0.64	20.00	40.00	60.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	013	0	1	01	01	H5050_013_0	6	2	Non-Preferred Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.28	12.00	24.00	36.00																					0.28	12.00	24.00	36.00																		12.00				0.28	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	013	0	1	01	01	H5050_013_0	6	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	013	0	1	01	01	H5050_013_0	6	4	Non-Preferred Brand	1	3	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					81.00	50	50	50																					50	50	50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	014	0	1	01	01	H5050_014_0	7	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.71	23.00	46.00	69.00																					0.71	23.00	46.00	69.00																		23.00				0.71	23.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	014	0	1	01	01	H5050_014_0	7	4	Non-Preferred Brand	1	3	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					89.70	50	50	50																					50	50	50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	014	0	1	01	01	H5050_014_0	7	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.15	5.00	10.00	15.00																					0.15	5.00	10.00	15.00																		5.00				0.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5050	014	0	1	01	01	H5050_014_0	7	2	Non-Preferred Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.30	15.00	30.00	45.00																					0.30	15.00	30.00	45.00																		15.00				0.30	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5087	001	0	1	01	01	H5087_001_0	5	4	Non-Preferred Brand	1	4	100000	1	1	111		01		111	1	31	62	93				1				31	62	93	31		31					59.75	25	25	25																												25	25	17					25	25	25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	5	3	Preferred Brand	1	4	000001	1	1	111		01		111	1	31	62	93				1				31	62	93	31		31					26.18	25	25	25																												25	25	17					25	25	25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	5	2	Non-Preferred Generic	1	4	000100	1	1	111		01		111	1	31	62	93				1				31	62	93	31		31					7.37	25	25	25																												25	25	17					25	25	25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	5	1	Preferred Generic	1	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	31										31			31		31					533.19	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	5	1	Preferred Generic	3	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	2
H5087	002	0	1	01	01	H5087_002_0	5	1	Preferred Generic	1	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	5	2	Non-Preferred Generic	1	4	000100	1	1	111		01		111	1	31	62	93				1				31	62	93	31		31					7.37	25	25	25																												25	25	17					25	25	25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	5	3	Preferred Brand	1	4	000001	1	1	111		01		111	1	31	62	93				1				31	62	93	31		31					26.18	25	25	25																												25	25	17					25	25	25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	5	4	Non-Preferred Brand	1	4	100000	1	1	111		01		111	1	31	62	93				1				31	62	93	31		31					59.75	25	25	25																												25	25	17					25	25	25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	31										31			31		31					533.19	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	5	1	Preferred Generic	3	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	2
H5087	005	0	1	01	01	H5087_005_0	5	1	Preferred Generic	1	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	.32	10.00	20.00	30.00																												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	005	0	1	01	01	H5087_005_0	5	1	Preferred Generic	3	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	005	0	1	01	01	H5087_005_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	31										31			31		31					703.81	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	3.06	95.00	190.00	285.00																												3.06	95.00	190.00	190.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	1.45	45.00	90.00	135.00																												1.45	45.00	90.00	90.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	.32	10.00	20.00	30.00																												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	009	0	1	01	01	H5087_009_0	5	1	Preferred Generic	3	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	009	0	1	01	01	H5087_009_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	31										31			31		31					703.81	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	009	0	1	01	01	H5087_009_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	3.06	95.00	190.00	285.00																												3.06	95.00	190.00	190.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	009	0	1	01	01	H5087_009_0	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	1.45	45.00	90.00	135.00																												1.45	45.00	90.00	90.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	009	0	1	01	01	H5087_009_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	.64	20.00	40.00	60.00																												.64	20.00	40.00	40.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	009	0	1	01	01	H5087_009_0	5	1	Preferred Generic	1	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	009	0	1	01	01	H5087_009_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	.64	20.00	40.00	60.00																												.64	20.00	40.00	40.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	010	0	1	01	01	H5087_010_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	2.90	90.00	180.00	270.00																												2.90	90.00	180.00	180.00				2.90	90.00	180.00	270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	1.29	40.00	80.00	120.00																												1.29	40.00	80.00	80.00				1.29	40.00	80.00	120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	.32	10.00	20.00	30.00																												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	5	1	Preferred Generic	1	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	31										31			31		31					703.81	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	0.32	10.00	20.00	30.00																												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	010	0	1	01	01	H5087_010_0	5	1	Preferred Generic	3	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	011	0	1	01	01	H5087_011_0	5	1	Preferred Generic	3	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	011	0	1	01	01	H5087_011_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	31										31			31		31					703.81	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	011	0	1	01	01	H5087_011_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	3.06	95.00	190.00	285.00																												3.06	95.00	190.00	190.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	011	0	1	01	01	H5087_011_0	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	1.45	45.00	90.00	135.00																												1.45	45.00	90.00	90.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	011	0	1	01	01	H5087_011_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	.32	10.00	20.00	30.00																												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	011	0	1	01	01	H5087_011_0	5	1	Preferred Generic	1	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	011	0	1	01	01	H5087_011_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	.32	10.00	20.00	30.00																												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	012	0	1	01	01	H5087_012_0	6	1	Preferred Generic	3	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	012	0	1	01	01	H5087_012_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	31										31			31		31					703.81	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	012	0	1	01	01	H5087_012_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	3.06	95.00	190.00	285.00																												3.06	95.00	190.00	190.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	012	0	1	01	01	H5087_012_0	6	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	1.45	45.00	90.00	135.00																												1.45	45.00	90.00	90.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	012	0	1	01	01	H5087_012_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	.32	10.00	20.00	30.00																												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	012	0	1	01	01	H5087_012_0	6	1	Preferred Generic	1	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	012	0	1	01	01	H5087_012_0	6	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	.32	10.00	20.00	30.00																												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	014	0	1	01	01	H5087_014_0	6	1	Preferred Generic	1	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	014	0	1	01	01	H5087_014_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	.32	10.00	20.00	30.00																												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	014	0	1	01	01	H5087_014_0	6	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	1.45	45.00	90.00	135.00																												1.45	45.00	90.00	90.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	014	0	1	01	01	H5087_014_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	3.06	95.00	190.00	285.00																												3.06	95.00	190.00	190.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	014	0	1	01	01	H5087_014_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	31										31			31		31					703.81	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	014	0	1	01	01	H5087_014_0	6	1	Preferred Generic	3	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	014	0	1	01	01	H5087_014_0	6	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	.32	10.00	20.00	30.00																												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	015	0	1	01	01	H5087_015_0	6	1	Preferred Generic	1	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	015	0	1	01	01	H5087_015_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	.32	10.00	20.00	30.00																												.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	015	0	1	01	01	H5087_015_0	6	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	1.45	45.00	90.00	135.00																												1.45	45.00	90.00	90.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	015	0	1	01	01	H5087_015_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	3.06	95.00	190.00	285.00																												3.06	95.00	190.00	190.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	015	0	1	01	01	H5087_015_0	6	1	Preferred Generic	3	4	001010	3	2	111		01		111	1	31	62	93				2				31	62	93	31		31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	015	0	1	01	01	H5087_015_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	31										31			31		31					703.81	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	015	0	1	01	01	H5087_015_0	6	2	Non-Preferred Generic	3	4	000100	1	2	111		01		111	1	31	62	93				1				31	62	93	31		31	0.32	10.00	20.00	30.00																												0.32	10.00	20.00	20.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5106	013	0	1	04	01	H5106_013_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	8	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								25.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	8	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1001.69	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	014	0	1	04	01	H5106_014_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	014	0	1	04	01	H5106_014_0	8	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								25.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	014	0	1	04	01	H5106_014_0	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	014	0	1	04	01	H5106_014_0	8	1	Generic	3	4	010000	1	1	110		01	100		1	31		90				1			90				31		31					16.70	50		50																							50																	50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5106	014	0	1	04	01	H5106_014_0	8	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1250.92	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	015	0	1	04	01	H5106_015_0	8	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								25.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	015	0	1	04	01	H5106_015_0	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	015	0	1	04	01	H5106_015_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	015	0	1	04	01	H5106_015_0	8	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					997.75	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	016	0	1	04	01	H5106_016_0	8	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								25.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	016	0	1	04	01	H5106_016_0	8	1	Generic	3	4	010000	1	1	110		01	100		1	31		90				1			90				31		31					17.03	50		50																							50																	50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5106	016	0	1	04	01	H5106_016_0	8	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1440.83	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	016	0	1	04	01	H5106_016_0	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	016	0	1	04	01	H5106_016_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	025	0	1	04	01	H5106_025_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.16	5.00		15.00																								12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	025	0	1	04	01	H5106_025_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.64	20.00		60.00																								50.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	025	0	1	04	01	H5106_025_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	025	0	1	04	01	H5106_025_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.90	90.00		270.00																								225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	025	0	1	04	01	H5106_025_0	10	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					864.38	30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.64	20.00		60.00																								50.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.16	5.00		15.00																								12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					992.39	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	028	0	1	04	01	H5106_028_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								112.50																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	028	0	1	04	01	H5106_028_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	028	0	1	04	01	H5106_028_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					966.59	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	028	0	1	04	01	H5106_028_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.16	5.00		15.00																								12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	028	0	1	04	01	H5106_028_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	.64	20.00		60.00																								50.00																		20.00				.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	.17	5.00	10.00	15.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.00	90.00	180.00	270.00																								180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	8	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31						25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5151	002	0	1	01	01	H5151_002_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H5151	002	0	1	01	01	H5151_002_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5151	002	0	1	01	01	H5151_002_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5151	002	0	1	01	01	H5151_002_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5151	002	0	1	01	01	H5151_002_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.67	20.00		60.00																								40.00																		20.00				0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5151	006	0	1	01	01	H5151_006_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H5151	006	0	1	01	01	H5151_006_0	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5151	006	0	1	01	01	H5151_006_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H5151	006	0	1	01	01	H5151_006_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5151	006	0	1	01	01	H5151_006_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5151	006	0	1	01	01	H5151_006_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5172	002	0	1	48	05	H5172_002_0	4	1	Generic Drugs	1	4	010000			110		01	100		1	31		93				1			93				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5172	002	0	1	48	05	H5172_002_0	4	5	Non-Medicare OTC Drugs	1	4	010010			110		01	100		1	31		93				1			93				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5172	002	0	1	48	05	H5172_002_0	4	4	Non-Medicare Rx Brand Drugs	1	4	000010			110		01	100		1	31		93				1			93				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5172	002	0	1	48	05	H5172_002_0	4	3	Non-Medicare Rx Generic Drugs	1	4	010000			110		01	100		1	31		93				1			93				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5172	002	0	1	48	05	H5172_002_0	4	2	Brand Drugs	1	4	000010			110		01	100		1	31		93				1			93				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1											
H5190	001	0	1	01	01	H5190_001_0	8	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5190	001	0	1	01	01	H5190_001_0	8	4	Injectable Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5190	001	0	1	01	01	H5190_001_0	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5190	001	0	1	01	01	H5190_001_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.45	45.00		45.00																								45.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5190	002	0	1	01	01	H5190_002_0	8	4	Injectable Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5190	002	0	1	01	01	H5190_002_0	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5190	002	0	1	01	01	H5190_002_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.45	45.00		45.00																								45.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5190	002	0	1	01	01	H5190_002_0	8	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5190	003	0	1	01	01	H5190_003_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.45	45.00		45.00																								45.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5190	003	0	1	01	01	H5190_003_0	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5190	003	0	1	01	01	H5190_003_0	8	4	Injectable Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5190	003	0	1	01	01	H5190_003_0	8	1	Generic	3	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs										1		
H5190	003	0	1	01	01	H5190_003_0	8	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5211	002	0	1	02	01	H5211_002_0	13	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	3.00	90.00	180.00	270.00																					3.00	90.00	180.00	270.00																		90.00				2.64	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	13	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	13	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.30	9.00	18.00	27.00																					.30	9.00	18.00	27.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	13	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	13	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		34					955.72	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	13	6	Vaccines	3	4	000010	1	2	010		01			1	30													30		34	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5211	002	0	1	02	01	H5211_002_0	13	6	Vaccines	1	4	000010	1	2	010		01			1	30													30		34	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	13	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	13	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	3.00	90.00	180.00	270.00																					3.00	90.00	180.00	270.00																		90.00				2.64	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	13	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	13	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.30	9.00	18.00	27.00																					.30	9.00	18.00	27.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	13	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		34					901.64	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	13	6	Vaccines	1	4	000010	1	2	010		01			1	30													30		34	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	13	6	Vaccines	3	4	000010	1	2	010		01			1	30													30		34	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5211	005	0	1	02	01	H5211_005_0	13	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	3.00	90.00	180.00	270.00																					3.00	90.00	180.00	270.00																		90.00				2.64	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	005	0	1	02	01	H5211_005_0	13	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	005	0	1	02	01	H5211_005_0	13	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.30	9.00	18.00	27.00																					.30	9.00	18.00	27.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	005	0	1	02	01	H5211_005_0	13	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	005	0	1	02	01	H5211_005_0	13	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		34					1178.71	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	005	0	1	02	01	H5211_005_0	13	6	Vaccines	1	4	000010	1	2	010		01			1	30													30		34	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	005	0	1	02	01	H5211_005_0	13	6	Vaccines	3	4	000010	1	2	010		01			1	30													30		34	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5214	003	0	1	04	01	H5214_003_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	003	0	1	04	01	H5214_003_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	003	0	1	04	01	H5214_003_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	003	0	1	04	01	H5214_003_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	003	0	1	04	01	H5214_003_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	003	0	1	04	01	H5214_003_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5214	003	0	1	04	01	H5214_003_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5214	003	0	1	04	01	H5214_003_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	003	0	1	04	01	H5214_003_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	003	0	1	04	01	H5214_003_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	004	0	1	04	01	H5214_004_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	004	0	1	04	01	H5214_004_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	004	0	1	04	01	H5214_004_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	004	0	1	04	01	H5214_004_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	004	0	1	04	01	H5214_004_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	004	0	1	04	01	H5214_004_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	004	0	1	04	01	H5214_004_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5214	004	0	1	04	01	H5214_004_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5214	004	0	1	04	01	H5214_004_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	004	0	1	04	01	H5214_004_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	008	0	1	04	01	H5214_008_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	008	0	1	04	01	H5214_008_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	008	0	1	04	01	H5214_008_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	008	0	1	04	01	H5214_008_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	008	0	1	04	01	H5214_008_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	008	0	1	04	01	H5214_008_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5214	008	0	1	04	01	H5214_008_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5214	008	0	1	04	01	H5214_008_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	008	0	1	04	01	H5214_008_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	008	0	1	04	01	H5214_008_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	009	0	1	04	01	H5214_009_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	009	0	1	04	01	H5214_009_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	009	0	1	04	01	H5214_009_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	009	0	1	04	01	H5214_009_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5214	009	0	1	04	01	H5214_009_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	009	0	1	04	01	H5214_009_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	009	0	1	04	01	H5214_009_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	009	0	1	04	01	H5214_009_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	009	0	1	04	01	H5214_009_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	009	0	1	04	01	H5214_009_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5214	011	0	1	04	01	H5214_011_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	011	0	1	04	01	H5214_011_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	011	0	1	04	01	H5214_011_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	011	0	1	04	01	H5214_011_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	011	0	1	04	01	H5214_011_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	011	0	1	04	01	H5214_011_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	011	0	1	04	01	H5214_011_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	011	0	1	04	01	H5214_011_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	011	0	1	04	01	H5214_011_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5214	011	0	1	04	01	H5214_011_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5214	012	0	1	04	01	H5214_012_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	012	0	1	04	01	H5214_012_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	012	0	1	04	01	H5214_012_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	012	0	1	04	01	H5214_012_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	012	0	1	04	01	H5214_012_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	012	0	1	04	01	H5214_012_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5214	012	0	1	04	01	H5214_012_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5214	012	0	1	04	01	H5214_012_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	012	0	1	04	01	H5214_012_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	012	0	1	04	01	H5214_012_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	014	0	1	04	01	H5214_014_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	014	0	1	04	01	H5214_014_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	014	0	1	04	01	H5214_014_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5214	014	0	1	04	01	H5214_014_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5214	014	0	1	04	01	H5214_014_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	014	0	1	04	01	H5214_014_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5214	014	0	1	04	01	H5214_014_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	014	0	1	04	01	H5214_014_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	014	0	1	04	01	H5214_014_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5214	014	0	1	04	01	H5214_014_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5215	002	0	1	04	01	H5215_002_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.03	1.00		2.00					.09	3.00		8.00					.03	1.00		2.00																		1.00				.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	9	2	Non-Preferred Generic	1	4	001100	1	2		110	01	110		1				31		90	1	31		90				31		31									.25	8.00		20.00					.41	13.00		33.00					.25	8.00		20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	9	3	Preferred Brand	1	4	000101	1	2		110	01	110		1				31		90	1	31		90				31		31									1.29	40.00		97.00					1.45	45.00		109.00					1.29	40.00		97.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.58	80.00		189.00					2.74	85.00		203.00					2.58	80.00		189.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.03	1.00		2.00					.09	3.00		8.00					.03	1.00		2.00																		1.00				.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5215	002	0	1	04	01	H5215_002_0	9	2	Non-Preferred Generic	3	4	001100	1	2		110	01	110		1				31		90	1	31		90				31		31									.29	9.00		21.00					.45	14.00		34.00					.29	9.00		21.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5215	005	0	1	04	01	H5215_005_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.03	1.00		2.00					.09	3.00		8.00					.03	1.00		2.00																		1.00				.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	9	2	Non-Preferred Generic	1	4	001100	1	2		110	01	110		1				31		90	1	31		90				31		31									.25	8.00		20.00					.41	13.00		33.00					.25	8.00		20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	9	3	Preferred Brand	1	4	000101	1	2		110	01	110		1				31		90	1	31		90				31		31									1.29	40.00		97.00					1.45	45.00		109.00					1.29	40.00		97.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.58	80.00		189.00					2.74	85.00		203.00					2.58	80.00		189.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.03	1.00		2.00					.09	3.00		8.00					.03	1.00		2.00																		1.00				.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5215	005	0	1	04	01	H5215_005_0	9	2	Non-Preferred Generic	3	4	001100	1	2		110	01	110		1				31		90	1	31		90				31		31									.29	9.00		21.00					.45	14.00		34.00					.29	9.00		21.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5215	007	0	1	04	01	H5215_007_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.03	1.00		3.00					.09	3.00		8.00					.03	1.00		3.00																		1.00				.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	9	2	Non-Preferred Generic	1	4	001100	1	2		110	01	110		1				31		90	1	31		90				31		31									.25	8.00		20.00					.41	13.00		26.00					.25	8.00		20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	9	3	Preferred Brand	1	4	000101	1	2		110	01	110		1				31		90	1	31		90				31		31									1.29	40.00		100.00					1.45	45.00		115.00					1.29	40.00		100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.58	80.00		200.00					2.74	85.00		208.00					2.58	80.00		200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	9	3	Preferred Brand	1	4	000101	1	2		110	01	110		1				31		90	1	31		90				31		31									1.29	40.00		97.00					1.45	45.00		109.00					1.29	40.00		97.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.58	80.00		189.00					2.74	85.00		203.00					2.58	80.00		189.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.03	1.00		2.00					.09	3.00		8.00					.03	1.00		2.00																		1.00				.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	9	2	Non-Preferred Generic	1	4	001100	1	2		110	01	110		1				31		90	1	31		90				31		31									.25	8.00		20.00					.41	13.00		33.00					.25	8.00		20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	001	0	1	04	01	H5216_001_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	001	0	1	04	01	H5216_001_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5216	001	0	1	04	01	H5216_001_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5216	001	0	1	04	01	H5216_001_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	003	0	1	04	01	H5216_003_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	003	0	1	04	01	H5216_003_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	003	0	1	04	01	H5216_003_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	003	0	1	04	01	H5216_003_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	003	0	1	04	01	H5216_003_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5216	003	0	1	04	01	H5216_003_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5216	003	0	1	04	01	H5216_003_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	003	0	1	04	01	H5216_003_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	003	0	1	04	01	H5216_003_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	003	0	1	04	01	H5216_003_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5216	006	0	1	04	01	H5216_006_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	006	0	1	04	01	H5216_006_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	006	0	1	04	01	H5216_006_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	006	0	1	04	01	H5216_006_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5216	009	0	1	04	01	H5216_009_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5216	009	0	1	04	01	H5216_009_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	009	0	1	04	01	H5216_009_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	009	0	1	04	01	H5216_009_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	009	0	1	04	01	H5216_009_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5216	009	0	1	04	01	H5216_009_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	010	0	1	04	01	H5216_010_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	010	0	1	04	01	H5216_010_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	010	0	1	04	01	H5216_010_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	010	0	1	04	01	H5216_010_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	010	0	1	04	01	H5216_010_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	010	0	1	04	01	H5216_010_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	010	0	1	04	01	H5216_010_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	010	0	1	04	01	H5216_010_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	010	0	1	04	01	H5216_010_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5216	010	0	1	04	01	H5216_010_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5253	004	0	1	01	01	H5253_004_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	004	0	1	01	01	H5253_004_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	004	0	1	01	01	H5253_004_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					565.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	004	0	1	01	01	H5253_004_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	004	0	1	01	01	H5253_004_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					462.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.23	7.00		21.00																															14.00							21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					421.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01			1	30		90				1							30		31	1.00	30.00		90.00																																										30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	5	1	Preferred Generic	1	3	001000	1	2	110		01			1	30		90				1							30		31	.26	8.00		24.00																																										8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	5	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31					250.00	32																																										32				32	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	5	4	Non-Preferred Brand	1	3	100000	1	2	110		01			1	30		90				1							30		31	3.16	95.00		285.00																																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	5	3	Preferred Brand	1	3	000001	1	2	110		01			1	30		90				1							30		31	1.50	45.00		135.00																																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	8	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31					279.64	30																																										30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	8	4	Non-Preferred Brand	1	3	100000	1	2	110		01			1	30		90				1							30		31	3.16	95.00		285.00																																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	8	2	Non-Preferred Generic	1	3	000100	1	2	110		01			1	30		90				1							30		31	1.00	30.00		90.00																																										30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	8	1	Preferred Generic	1	3	001000	1	2	110		01			1	30		90				1							30		31	.26	8.00		24.00																																										8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	8	3	Preferred Brand	1	3	000001	1	2	110		01			1	30		90				1							30		31	1.50	45.00		135.00																																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5280	001	0	1	48	05	H5280_001_0	5	4	Non-Medicare Rx Brand Drugs	1	4	000010			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5280	001	0	1	48	05	H5280_001_0	5	5	Non-Medicare OTC Drugs	1	4	010010			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5280	001	0	1	48	05	H5280_001_0	5	3	Non-Medicare Rx Generic Drugs	1	4	010000			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5280	001	0	1	48	05	H5280_001_0	5	2	Brand Drugs	1	4	000010			111		01	111		1	31	60	90				1	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1											
H5280	001	0	1	48	05	H5280_001_0	5	1	Generic Drugs	1	4	010000			111		01	111		1	31	60	90				1	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1											
H5291	001	0	1	01	01	H5291_001_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5291	001	0	1	01	01	H5291_001_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5291	001	0	1	01	01	H5291_001_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5291	001	0	1	01	01	H5291_001_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.96	89.00		267.00																												2.96	89.00		257.00				2.96	89.00		267.00				89.00				2.87	89.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5291	001	0	1	01	01	H5291_001_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5291	001	0	1	01	01	H5291_001_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5291	001	0	1	01	01	H5291_001_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5291	001	0	1	01	01	H5291_001_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5291	001	0	1	01	01	H5291_001_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.96	89.00		267.00																												2.96	89.00		257.00				2.96	89.00		267.00				89.00				2.87	89.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5291	001	0	1	01	01	H5291_001_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5291	002	0	1	01	01	H5291_002_0	5	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.23	7.00		21.00												0.03	1.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5291	002	0	1	01	01	H5291_002_0	5	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.30	9.00		27.00												0.10	3.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5291	002	0	1	01	01	H5291_002_0	5	5	Specialty Tier	3	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	27							1.00	27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5291	002	0	1	01	01	H5291_002_0	5	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.00	90.00		270.00					3.16	95.00		285.00												3.00	90.00		260.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5291	002	0	1	01	01	H5291_002_0	5	3	Preferred Brand	3	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													21.00	15		15					35.00	25		25												15		15					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5291	002	0	1	01	01	H5291_002_0	5	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													13.00	15		15					24.00	25		25												15		15					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5291	002	0	1	01	01	H5291_002_0	5	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													46.00	30		30					77.00	50		50												30		30					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5291	002	0	1	01	01	H5291_002_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	27							1.00	27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5291	002	0	1	01	01	H5291_002_0	5	2	Non-Preferred Generic	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.30	9.00		27.00												0.10	3.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5294	001	0	1	01	01	H5294_001_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.45	45.00		45.00																								45.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5294	001	0	1	01	01	H5294_001_0	7	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5294	001	0	1	01	01	H5294_001_0	7	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5294	001	0	1	01	01	H5294_001_0	7	4	Injectable Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H5302	003	0	1	02	01	H5302_003_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					2.93	88.00	176.00	264.00					2.83	85.00	170.00	255.00																		88.00				2.83	88.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5302	003	0	1	02	01	H5302_003_0	9	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5302	003	0	1	02	01	H5302_003_0	9	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.73	22.00	44.00	66.00					.83	25.00	50.00	75.00					.73	22.00	44.00	44.00																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5302	003	0	1	02	01	H5302_003_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.10	3.00	6.00	9.00					.20	6.00	12.00	18.00					.10	3.00	6.00	0.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5302	003	0	1	02	01	H5302_003_0	9	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31														33								33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	016	0	1	01	01	H5322_016_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															20.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	016	0	1	01	01	H5322_016_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	016	0	1	01	01	H5322_016_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	016	0	1	01	01	H5322_016_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	016	0	1	01	01	H5322_016_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					469.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	017	0	1	02	01	H5322_017_0	5	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	017	0	1	02	01	H5322_017_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.33	10.00		30.00																															20.00							30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	017	0	1	02	01	H5322_017_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	017	0	1	02	01	H5322_017_0	5	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	2.83	85.00		255.00																															245.00							255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	017	0	1	02	01	H5322_017_0	5	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					283.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	019	0	1	02	01	H5322_019_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	2.66	80.00		240.00																															230.00							240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	019	0	1	02	01	H5322_019_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					359.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	019	0	1	02	01	H5322_019_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.33	40.00		120.00																															110.00							120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	019	0	1	02	01	H5322_019_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	019	0	1	02	01	H5322_019_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	020	0	1	02	01	H5322_020_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	020	0	1	02	01	H5322_020_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					469.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	020	0	1	02	01	H5322_020_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	2.83	85.00		255.00																															245.00							255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	020	0	1	02	01	H5322_020_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	020	0	1	02	01	H5322_020_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.33	10.00		30.00																															20.00							30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	021	0	1	02	01	H5322_021_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.33	10.00		30.00																															20.00							30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	021	0	1	02	01	H5322_021_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	021	0	1	02	01	H5322_021_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	021	0	1	02	01	H5322_021_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	2.83	85.00		255.00																															245.00							255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	021	0	1	02	01	H5322_021_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					283.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	023	0	1	02	01	H5322_023_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	023	0	1	02	01	H5322_023_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					538.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	023	0	1	02	01	H5322_023_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	023	0	1	02	01	H5322_023_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	023	0	1	02	01	H5322_023_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	5	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	5	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					538.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															20.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	5	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5355	001	0	1	48	05	H5355_001_0	5	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01	110		1	30		90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5355	001	0	1	48	05	H5355_001_0	5	1	Generic Drugs	1	4	010000			110		01	110		1	30		90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H5355	001	0	1	48	05	H5355_001_0	5	2	Brand Drugs	1	4	000001			110		01	110		1	30		90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H5378	016	0	1	04	01	H5378_016_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	016	0	1	04	01	H5378_016_0	8	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	016	0	1	04	01	H5378_016_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	016	0	1	04	01	H5378_016_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	016	0	1	04	01	H5378_016_0	8	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	184	0	1	04	01	H5378_184_0	7	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	184	0	1	04	01	H5378_184_0	7	2	Non-Preferred Generic	1	3	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	184	0	1	04	01	H5378_184_0	7	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	184	0	1	04	01	H5378_184_0	7	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	184	0	1	04	01	H5378_184_0	7	4	Non-Preferred Brand	1	3	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	190	0	1	04	01	H5378_190_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	190	0	1	04	01	H5378_190_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	190	0	1	04	01	H5378_190_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	190	0	1	04	01	H5378_190_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5378	190	0	1	04	01	H5378_190_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	6	2	Brand	1	4	000010	1	2		110	01			1				30		90	2							30		31									0.00	0.00		0.00					0.33	10.00		30.00																										10.00				0.32	10.00		Generic, Brand, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	6	1	Generic	1	4	010000	3	2		110	01			1				30		90	2							30		31									0.00	0.00		0.00					0.16	5.00		15.00																										5.00				0.16	5.00		Generic, Brand, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	6	1	Generic	3	4	010000	3	2		110	01			1				30		90	2							30		31									0.00	0.00		0.00					0.16	5.00		15.00																										5.00				0.16	5.00		Generic, Brand, Specialty Tier										1		
H5410	001	0	1	01	01	H5410_001_0	6	3	Specialty Tier	1	4	000010	1	1		010	01			1				30										30		31													736.87	33							736.87	33																										33				33	Generic, Brand, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	4	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5410	018	0	1	02	01	H5410_018_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5410	018	0	1	02	01	H5410_018_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					290.61	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00		245.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	009	0	1	01	01	H5414_009_0	5	1	Generic	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.13	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	009	0	1	01	01	H5414_009_0	5	5	Select Care Drugs	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.13	4.00	8.00	12.00					4.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	009	0	1	01	01	H5414_009_0	5	2	Preferred Brand	1	3	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	009	0	1	01	01	H5414_009_0	5	3	Non-Preferred Brand	1	3	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	009	0	1	01	01	H5414_009_0	5	4	Specialty Tier	1	3	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	019	0	1	01	01	H5414_019_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	019	0	1	01	01	H5414_019_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	019	0	1	01	01	H5414_019_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	019	0	1	01	01	H5414_019_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5414	019	0	1	01	01	H5414_019_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	019	0	1	01	01	H5414_019_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	023	0	1	01	01	H5414_023_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5414	023	0	1	01	01	H5414_023_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	023	0	1	01	01	H5414_023_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	023	0	1	01	01	H5414_023_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	023	0	1	01	01	H5414_023_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	023	0	1	01	01	H5414_023_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	024	0	1	01	01	H5414_024_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	024	0	1	01	01	H5414_024_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5414	024	0	1	01	01	H5414_024_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	024	0	1	01	01	H5414_024_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	024	0	1	01	01	H5414_024_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5414	024	0	1	01	01	H5414_024_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5415	056	0	1	04	01	H5415_056_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	056	0	1	04	01	H5415_056_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	056	0	1	04	01	H5415_056_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	056	0	1	04	01	H5415_056_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5415	056	0	1	04	01	H5415_056_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5415	056	0	1	04	01	H5415_056_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	066	0	1	04	01	H5415_066_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	066	0	1	04	01	H5415_066_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	066	0	1	04	01	H5415_066_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	066	0	1	04	01	H5415_066_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	066	0	1	04	01	H5415_066_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5415	066	0	1	04	01	H5415_066_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5415	066	0	1	04	01	H5415_066_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	066	0	1	04	01	H5415_066_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	066	0	1	04	01	H5415_066_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	066	0	1	04	01	H5415_066_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	069	0	1	04	01	H5415_069_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	069	0	1	04	01	H5415_069_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	069	0	1	04	01	H5415_069_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5415	069	0	1	04	01	H5415_069_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5415	069	0	1	04	01	H5415_069_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	069	0	1	04	01	H5415_069_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	069	0	1	04	01	H5415_069_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	069	0	1	04	01	H5415_069_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	069	0	1	04	01	H5415_069_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	069	0	1	04	01	H5415_069_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	070	0	1	04	01	H5415_070_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	070	0	1	04	01	H5415_070_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	070	0	1	04	01	H5415_070_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	070	0	1	04	01	H5415_070_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5415	070	0	1	04	01	H5415_070_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5415	070	0	1	04	01	H5415_070_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	070	0	1	04	01	H5415_070_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	070	0	1	04	01	H5415_070_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	070	0	1	04	01	H5415_070_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	070	0	1	04	01	H5415_070_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5416	016	0	1	01	01	H5416_016_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5416	016	0	1	01	01	H5416_016_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.36	11.00		33.00																												0.36	11.00		0.00				0.36	11.00		33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5416	016	0	1	01	01	H5416_016_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5416	016	0	1	01	01	H5416_016_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5416	016	0	1	01	01	H5416_016_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5416	016	0	1	01	01	H5416_016_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5416	016	0	1	01	01	H5416_016_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.36	11.00		33.00																												0.36	11.00		0.00				0.36	11.00		33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5416	016	0	1	01	01	H5416_016_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5416	016	0	1	01	01	H5416_016_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5416	016	0	1	01	01	H5416_016_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	001	0	1	02	01	H5420_001_0	5	1	Preferred Generic	1	4	001000	3	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	001	0	1	02	01	H5420_001_0	5	2	Preferred Brand	1	4	010001	3	2	010		01			1	30													30		31	.16	5.00																																												5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	001	0	1	02	01	H5420_001_0	5	3	Non-Preferred Brand	1	4	100100	1	2	010		01			1	30													30		31	.83	25.00																																												25.00				.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	001	0	1	02	01	H5420_001_0	5	4	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					645.00	33																																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	001	0	1	02	01	H5420_001_0	5	1	Preferred Generic	3	4	001000	3	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5420	003	0	1	01	01	H5420_003_0	3	1	Preferred Generic	3	4	001000	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5420	003	0	1	01	01	H5420_003_0	3	4	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					389.00	33																																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	3	1	Preferred Generic	1	4	001000	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	3	2	Preferred Brand	1	4	010001	1	2	010		01			1	30													30		31	1.00	30.00																																												30.00				.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	3	3	Non-Preferred Brand	1	4	100100	1	2	010		01			1	30													30		31	2.96	89.00																																												89.00				2.87	89.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	02	01	H5420_006_0	4	4	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					396.00	25																																										25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	02	01	H5420_006_0	4	3	Non-Preferred Brand	1	4	100100	1	1	010		01			1	30													30		31					49.00	25																																										25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	02	01	H5420_006_0	4	2	Preferred Brand	1	4	010001	1	1	010		01			1	30													30		31					43.00	25																																										25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	02	01	H5420_006_0	4	1	Preferred Generic	1	4	001000	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	02	01	H5420_006_0	4	1	Preferred Generic	3	4	001000	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5422	002	0	1	01	01	H5422_002_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.09	3.00	6.00	9.00					.24	8.00	16.00	24.00					.09	3.00	6.00	6.00																		8.00				.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5422	002	0	1	01	01	H5422_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.29	10.00	20.00	30.00					.44	15.00	30.00	45.00					.29	10.00	20.00	20.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5422	002	0	1	01	01	H5422_002_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5422	002	0	1	01	01	H5422_002_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5422	002	0	1	01	01	H5422_002_0	7	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													70.00	33	33	33					70.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5422	002	0	1	01	01	H5422_002_0	7	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5422	006	0	1	01	01	H5422_006_0	7	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5422	006	0	1	01	01	H5422_006_0	7	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.47	16.00	32.00	48.00					.62	21.00	42.00	63.00					.47	16.00	32.00	32.00																		21.00				.62	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5422	006	0	1	01	01	H5422_006_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5422	006	0	1	01	01	H5422_006_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5422	006	0	1	01	01	H5422_006_0	7	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													59.00	33	33	33					59.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5422	006	0	1	01	01	H5422_006_0	7	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5424	001	0	1	04	01	H5424_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5424	001	0	1	04	01	H5424_001_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					557.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5424	001	0	1	04	01	H5424_001_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5424	001	0	1	04	01	H5424_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5424	001	0	1	04	01	H5424_001_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5425	001	0	1	01	01	H5425_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	80.00	80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.74	85.00	170.00	255.00																					2.74	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					544.95	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.41	75.00	150.00	225.00																					2.41	75.00	150.00	150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	80.00	80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.25	8.00	16.00	24.00																					0.25	8.00	16.00	16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					500.39	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.25	8.00	16.00	24.00																					0.25	8.00	16.00	16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	004	0	1	01	01	H5425_004_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	004	0	1	01	01	H5425_004_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.25	8.00	16.00	24.00																					0.25	8.00	16.00	16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					602.66	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.58	80.00	160.00	240.00																					2.58	80.00	160.00	160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	006	0	1	01	01	H5425_006_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					549.54	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.74	85.00	170.00	255.00																					2.74	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	80.00	80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	6	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	6	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	006	0	1	01	01	H5425_006_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	007	0	1	01	01	H5425_007_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	80.00	80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.74	85.00	170.00	255.00																					2.74	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					570.29	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	6	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	007	0	1	01	01	H5425_007_0	6	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	008	0	1	01	01	H5425_008_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	80.00	80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.74	85.00	170.00	255.00																					2.74	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	7	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	008	0	1	01	01	H5425_008_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	008	0	1	01	01	H5425_008_0	7	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					561.10	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	80.00	80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	7	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	009	0	1	01	01	H5425_009_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					516.27	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.74	85.00	170.00	255.00																					2.74	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	7	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	019	0	1	01	01	H5425_019_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.74	85.00	170.00	255.00																					2.74	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					396.04	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	6	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.74	85.00	170.00	255.00																					2.74	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	6	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					690.19	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	022	0	1	01	01	H5425_022_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	022	0	1	01	01	H5425_022_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	022	0	1	01	01	H5425_022_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.58	80.00	160.00	240.00																					2.58	80.00	160.00	160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	022	0	1	01	01	H5425_022_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	022	0	1	01	01	H5425_022_0	4	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	022	0	1	01	01	H5425_022_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					646.29	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					504.25	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	028	0	1	01	01	H5425_028_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	028	0	1	01	01	H5425_028_0	5	6	Select Care Drugs	3	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	028	0	1	01	01	H5425_028_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	80.00	80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	5	6	Select Care Drugs	3	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	033	0	1	01	01	H5425_033_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	033	0	1	01	01	H5425_033_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	033	0	1	01	01	H5425_033_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					493.45	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	80.00	80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	034	0	1	01	01	H5425_034_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	034	0	1	01	01	H5425_034_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	5	6	Select Care Drugs	3	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	034	0	1	01	01	H5425_034_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	80.00	80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					510.99	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	035	0	1	01	01	H5425_035_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	035	0	1	01	01	H5425_035_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	035	0	1	01	01	H5425_035_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	80.00	80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	035	0	1	01	01	H5425_035_0	4	6	Select Care Drugs	3	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	035	0	1	01	01	H5425_035_0	4	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	035	0	1	01	01	H5425_035_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	035	0	1	01	01	H5425_035_0	4	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	035	0	1	01	01	H5425_035_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					510.99	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	035	0	1	01	01	H5425_035_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					545.16	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.41	75.00	150.00	225.00																					2.41	75.00	150.00	150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	3	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					493.43	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	3	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	3	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	047	0	1	01	01	H5425_047_0	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	047	0	1	01	01	H5425_047_0	3	6	Select Care Drugs	3	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	047	0	1	01	01	H5425_047_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	3	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					510.97	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	3	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	3	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	048	0	1	01	01	H5425_048_0	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	048	0	1	01	01	H5425_048_0	3	6	Select Care Drugs	3	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	048	0	1	01	01	H5425_048_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.22	7.00	14.00	21.00																					0.22	7.00	14.00	14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	049	0	1	01	01	H5425_049_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	049	0	1	01	01	H5425_049_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.48	15.00	30.00	45.00																					0.48	15.00	30.00	30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	049	0	1	01	01	H5425_049_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	049	0	1	01	01	H5425_049_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	049	0	1	01	01	H5425_049_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					510.57	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	049	0	1	01	01	H5425_049_0	4	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	050	0	1	01	01	H5425_050_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	050	0	1	01	01	H5425_050_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	050	0	1	01	01	H5425_050_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	050	0	1	01	01	H5425_050_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	050	0	1	01	01	H5425_050_0	4	6	Select Care Drugs	3	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	050	0	1	01	01	H5425_050_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	050	0	1	01	01	H5425_050_0	4	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	050	0	1	01	01	H5425_050_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					510.77	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	051	0	1	01	01	H5425_051_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	051	0	1	01	01	H5425_051_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					502.60	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	051	0	1	01	01	H5425_051_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	051	0	1	01	01	H5425_051_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	051	0	1	01	01	H5425_051_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.38	12.00	24.00	36.00																					0.38	12.00	24.00	24.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	051	0	1	01	01	H5425_051_0	4	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5427	053	0	1	01	01	H5427_053_0	5	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	053	0	1	01	01	H5427_053_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.33	40.00		120.00																					1.33	40.00		80.00																		40.00				1.29	40.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	053	0	1	01	01	H5427_053_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	3.16	95.00		285.00																					3.16	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	053	0	1	01	01	H5427_053_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	054	0	1	01	01	H5427_054_0	4	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	054	0	1	01	01	H5427_054_0	4	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	054	0	1	01	01	H5427_054_0	4	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.16	35.00		105.00																					1.16	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	054	0	1	01	01	H5427_054_0	4	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	6	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5427	059	0	1	01	01	H5427_059_0	6	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	6	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	6	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		60.00																		30.00				0.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	6	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	4	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5427	060	0	1	01	01	H5427_060_0	4	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	4	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		60.00																		30.00				0.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	4	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	4	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	070	0	1	01	01	H5427_070_0	4	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	070	0	1	01	01	H5427_070_0	4	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	070	0	1	01	01	H5427_070_0	4	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	070	0	1	01	01	H5427_070_0	4	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5427	070	0	1	01	01	H5427_070_0	4	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	0.66	20.00		60.00																					0.66	20.00		40.00																		20.00				0.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	072	0	1	01	01	H5427_072_0	4	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	072	0	1	01	01	H5427_072_0	4	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		60.00																		30.00				0.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	072	0	1	01	01	H5427_072_0	4	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	072	0	1	01	01	H5427_072_0	4	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	076	0	1	01	01	H5427_076_0	4	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	076	0	1	01	01	H5427_076_0	4	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	076	0	1	01	01	H5427_076_0	4	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5427	076	0	1	01	01	H5427_076_0	4	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	076	0	1	01	01	H5427_076_0	4	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	0.66	20.00		60.00																					0.66	20.00		40.00																		20.00				0.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	4	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	4	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		60.00																		30.00				0.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	4	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	4	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	082	0	1	01	01	H5427_082_0	6	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	082	0	1	01	01	H5427_082_0	6	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		60.00																		30.00				0.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	082	0	1	01	01	H5427_082_0	6	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	082	0	1	01	01	H5427_082_0	6	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	5	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		60.00																		30.00				0.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	3	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	3	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	0.66	20.00		60.00																					0.66	20.00		40.00																		20.00				0.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	3	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.16	65.00		195.00																					2.16	65.00		130.00																		65.00				2.09	65.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	3	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	3	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5428	001	0	1	01	01	H5428_001_0	9	1	Generic	1	4	010000	1	2	110		01			1	31		93				2							31		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Generic, Brand												
H5428	001	0	1	01	01	H5428_001_0	9	2	Brand	1	4	000010	1	2	110		01			1	31		93				2							31		31	0.00	45.00		135.00																																										45.00				0.00	45.00		Generic, Brand												
H5430	001	0	1	01	01	H5430_001_0	6	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	2							30		31													505.93	25		25					505.93	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	6	4	Non-Preferred Brand	1	4	100100	1	1		110	01			1				30		90	2							30		31													63.74	25		25					63.74	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	6	3	Preferred Brand	1	4	000001	1	1		110	01			1				30		90	2							30		31													67.66	25		25					67.66	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	6	2	Non-Preferred Generic	1	4	000100	1	1		110	01			1				30		90	2							30		31													6.96	25		25					6.96	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	6	1	Preferred Generic	1	4	001000	1	1		110	01			1				30		90	2							30		31													0.00	0		0					2.28	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5431	001	0	1	01	01	H5431_001_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													200.00	25							200.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2		010	01			1				30										30		31									0.00	0.00							1.47	50.00																												50.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	6	3	Preferred Brand	1	4	000001	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2		010	01			1				30										30		31									0.00	0.00							.29	10.00																												10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	6	6	Supplemental Brand and Generic Drugs	1	4	010010	2	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	6	1	Preferred Generic	1	4	001000	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	002	0	1	01	01	H5431_002_0	6	1	Preferred Generic	1	4	001000	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	002	0	1	01	01	H5431_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2		010	01			1				30										30		31									0.00	0.00							.29	10.00																												10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	002	0	1	01	01	H5431_002_0	6	6	Supplemental Brand and Generic Drugs	1	4	010010	2	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	002	0	1	01	01	H5431_002_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													200.00	25							200.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	002	0	1	01	01	H5431_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2		010	01			1				30										30		31									0.00	0.00							1.47	50.00																												50.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	002	0	1	01	01	H5431_002_0	6	3	Preferred Brand	1	4	000001	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	005	0	1	01	01	H5431_005_0	8	1	Preferred Generic	1	4	001000	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	005	0	1	01	01	H5431_005_0	8	2	Non-Preferred Generic	1	4	000100	1	2		010	01			1				30										30		31									0.00	0.00							.29	10.00																												10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	005	0	1	01	01	H5431_005_0	8	3	Preferred Brand	1	4	000001	1	1		010	01			1				30										30		31													35.00	25							35.00	25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	005	0	1	01	01	H5431_005_0	8	4	Non-Preferred Brand	1	4	100000	1	1		010	01			1				30										30		31													80.00	33							80.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	005	0	1	01	01	H5431_005_0	8	6	Supplemental Brand and Generic Drugs	3	4	010010	2	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	005	0	1	01	01	H5431_005_0	8	1	Preferred Generic	3	4	001000	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	005	0	1	01	01	H5431_005_0	8	6	Supplemental Brand and Generic Drugs	1	4	010010	2	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	005	0	1	01	01	H5431_005_0	8	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													200.00	25							200.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	005	0	1	01	01	H5431_005_0	8	2	Non-Preferred Generic	3	4	000100	1	2		010	01			1				30										30		31									0.00	0.00							.29	10.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	006	0	1	01	01	H5431_006_0	6	2	Non-Preferred Generic	1	4	000100	1	1	010		01			1	30													30		31					8.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	6	3	Preferred Brand	1	4	000001	1	1	010		01			1	30													30		31					30.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	6	4	Non-Preferred Brand	1	4	100000	1	1	010		01			1	30													30		31					45.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					200.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	6	6	Supplemental Brand and Generic Drugs	1	4	010010	2	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	6	6	Supplemental Brand and Generic Drugs	3	4	010010	2	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	006	0	1	01	01	H5431_006_0	6	1	Preferred Generic	1	4	001000	1	1	010		01			1	30													30		31					8.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	007	0	1	01	01	H5431_007_0	6	4	Non-Preferred Brand	1	4	100000	1	2		010	01			1				30										30		31									0.00	0.00							1.47	50.00																												50.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	007	0	1	01	01	H5431_007_0	6	3	Preferred Brand	1	4	000001	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	007	0	1	01	01	H5431_007_0	6	2	Non-Preferred Generic	1	4	000100	1	2		010	01			1				30										30		31									0.00	0.00							.29	10.00																												10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	007	0	1	01	01	H5431_007_0	6	1	Preferred Generic	1	4	001000	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	007	0	1	01	01	H5431_007_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													200.00	25							200.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	007	0	1	01	01	H5431_007_0	6	6	Supplemental Brand and Generic Drugs	1	4	010010	2	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	008	0	1	01	01	H5431_008_0	6	4	Non-Preferred Brand	1	4	100000	1	2		010	01			1				30										30		31									0.00	0.00							1.47	50.00																												50.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	008	0	1	01	01	H5431_008_0	6	3	Preferred Brand	1	4	000001	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	008	0	1	01	01	H5431_008_0	6	2	Non-Preferred Generic	1	4	000100	1	2		010	01			1				30										30		31									0.00	0.00							.29	10.00																												10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	008	0	1	01	01	H5431_008_0	6	1	Preferred Generic	1	4	001000	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	008	0	1	01	01	H5431_008_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													200.00	25							200.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	008	0	1	01	01	H5431_008_0	6	6	Supplemental Brand and Generic Drugs	1	4	010010	2	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	009	0	1	01	01	H5431_009_0	7	1	Preferred Generic	1	4	001000	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	009	0	1	01	01	H5431_009_0	7	2	Non-Preferred Generic	1	4	000100	1	2		010	01			1				30										30		31									0.00	0.00							.29	10.00																												10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	009	0	1	01	01	H5431_009_0	7	3	Preferred Brand	1	4	000001	1	1		010	01			1				30										30		31													35.00	25							35.00	25																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	009	0	1	01	01	H5431_009_0	7	4	Non-Preferred Brand	1	4	100000	1	1		010	01			1				30										30		31													80.00	33							80.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	009	0	1	01	01	H5431_009_0	7	6	Supplemental Brand and Generic Drugs	3	4	010010	2	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	009	0	1	01	01	H5431_009_0	7	6	Supplemental Brand and Generic Drugs	1	4	010010	2	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	009	0	1	01	01	H5431_009_0	7	1	Preferred Generic	3	4	001000	1	2		010	01			1				30										30		31									0.00	0.00							0.00	0.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	009	0	1	01	01	H5431_009_0	7	2	Non-Preferred Generic	3	4	000100	1	2		010	01			1				30										30		31									0.00	0.00							.29	10.00																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	009	0	1	01	01	H5431_009_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													200.00	33							200.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5433	001	0	1	01	01	H5433_001_0	11	2	Brand	1	4	000010	1	2	110		10			1	30		90				1								29	31	0.00	0.00		0.00																																											0.00			0.00	0.00		Generic, Brand												
H5433	001	0	1	01	01	H5433_001_0	11	1	Generic	1	4	010000	1	2	110		10			1	30		90				1								29	31	0.00	0.00		0.00																																											0.00			0.00	0.00		Generic, Brand												
H5434	002	0	1	04	01	H5434_002_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.06	2.00		6.00																					.06	2.00		6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.16	5.00		15.00																					.16	5.00		15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	.96	30.00		90.00																					.96	30.00		90.00																		30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	10	5	Specialty Tier	3	4	101101	1	1	110		01	110		1	31		90				1	31		90				31		31					1602.51	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5434	002	0	1	04	01	H5434_002_0	10	5	Specialty Tier	1	4	101101	1	1	110		01	110		1	31		90				1	31		90				31		31					1602.51	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.06	2.00		6.00																					.06	2.00		6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5434	002	0	1	04	01	H5434_002_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.16	5.00		15.00																					.16	5.00		15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5434	002	0	1	04	01	H5434_002_0	10	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.41	75.00		225.00																					2.41	75.00		225.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	014	0	1	09	04	H5435_014_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	014	0	1	09	04	H5435_014_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															20.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	014	0	1	09	04	H5435_014_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.46	44.00		132.00																															122.00							132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	014	0	1	09	04	H5435_014_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	014	0	1	09	04	H5435_014_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					619.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															20.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.46	44.00		132.00																															122.00							132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					689.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5439	001	0	1	04	01	H5439_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00				7.00				.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	001	0	1	04	01	H5439_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.83	25.00	50.00	75.00																												.83	25.00	50.00	50.00				.83	25.00	50.00	75.00				25.00				.73	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	001	0	1	04	01	H5439_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	001	0	1	04	01	H5439_001_0	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	001	0	1	04	01	H5439_001_0	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					420.00	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	001	0	1	04	01	H5439_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	002	0	1	04	01	H5439_002_0	6	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	002	0	1	04	01	H5439_002_0	6	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	002	0	1	04	01	H5439_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	002	0	1	04	01	H5439_002_0	6	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					340.00	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	002	0	1	04	01	H5439_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.66	20.00	40.00	60.00																												.66	20.00	40.00	40.00				.66	20.00	40.00	60.00				20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	002	0	1	04	01	H5439_002_0	6	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00				3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	7	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	7	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					406.00	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	7	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	7	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00				3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.66	20.00	40.00	60.00																												.66	20.00	40.00	40.00				.66	20.00	40.00	60.00				20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	7	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	006	0	1	04	01	H5439_006_0	7	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	006	0	1	04	01	H5439_006_0	7	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00				3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	006	0	1	04	01	H5439_006_0	7	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	006	0	1	04	01	H5439_006_0	7	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					380.00	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	006	0	1	04	01	H5439_006_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.66	20.00	40.00	60.00																												.66	20.00	40.00	40.00				.66	20.00	40.00	60.00				20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	006	0	1	04	01	H5439_006_0	7	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	007	0	1	04	01	H5439_007_0	7	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	007	0	1	04	01	H5439_007_0	7	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					282.00	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	007	0	1	04	01	H5439_007_0	7	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	007	0	1	04	01	H5439_007_0	7	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00				3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	007	0	1	04	01	H5439_007_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.66	20.00	40.00	60.00																												.66	20.00	40.00	40.00				.66	20.00	40.00	60.00				20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	007	0	1	04	01	H5439_007_0	7	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	008	0	1	04	01	H5439_008_0	7	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	008	0	1	04	01	H5439_008_0	7	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00				3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	008	0	1	04	01	H5439_008_0	7	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	008	0	1	04	01	H5439_008_0	7	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					383.00	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	008	0	1	04	01	H5439_008_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.66	20.00	40.00	60.00																												.66	20.00	40.00	40.00				.66	20.00	40.00	60.00				20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	008	0	1	04	01	H5439_008_0	7	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	009	0	1	04	01	H5439_009_0	7	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	125.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	009	0	1	04	01	H5439_009_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.66	20.00	40.00	60.00																												.66	20.00	40.00	40.00				.66	20.00	40.00	60.00				20.00				.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	009	0	1	04	01	H5439_009_0	7	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00				3.00				.08	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	009	0	1	04	01	H5439_009_0	7	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	275.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	009	0	1	04	01	H5439_009_0	7	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					409.00	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	009	0	1	04	01	H5439_009_0	7	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5471	001	0	1	01	01	H5471_001_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	001	0	1	01	01	H5471_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	2.50	75.00																																												75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	001	0	1	01	01	H5471_001_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	001	0	1	01	01	H5471_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	001	0	1	01	01	H5471_001_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	001	0	1	01	01	H5471_001_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	001	0	1	01	01	H5471_001_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	0.33	10.00																																												10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	6	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	003	0	1	02	01	H5471_003_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	003	0	1	02	01	H5471_003_0	6	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	003	0	1	02	01	H5471_003_0	6	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	003	0	1	02	01	H5471_003_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	003	0	1	02	01	H5471_003_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.50	15.00		45.00																								45.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	003	0	1	02	01	H5471_003_0	6	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	1.00	30.00																																												30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	003	0	1	02	01	H5471_003_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	004	0	1	01	01	H5471_004_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	004	0	1	01	01	H5471_004_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	1.83	55.00																																												55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	004	0	1	01	01	H5471_004_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.33	40.00		120.00																								120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	004	0	1	01	01	H5471_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	004	0	1	01	01	H5471_004_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	004	0	1	01	01	H5471_004_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	004	0	1	01	01	H5471_004_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	005	0	1	01	01	H5471_005_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	005	0	1	01	01	H5471_005_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	005	0	1	01	01	H5471_005_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	005	0	1	01	01	H5471_005_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.67	20.00		60.00																								60.00																		20.00				0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	005	0	1	01	01	H5471_005_0	6	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	1.83	55.00																																												55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	005	0	1	01	01	H5471_005_0	6	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	005	0	1	01	01	H5471_005_0	6	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	007	0	1	01	01	H5471_007_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	007	0	1	01	01	H5471_007_0	6	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	007	0	1	01	01	H5471_007_0	6	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	007	0	1	01	01	H5471_007_0	6	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	3.00	90.00																																												90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	007	0	1	01	01	H5471_007_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	007	0	1	01	01	H5471_007_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	007	0	1	01	01	H5471_007_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	008	0	1	01	01	H5471_008_0	5	1	Preferred Generic	1	4	001000	3	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	5	3	Preferred Brand	1	4	000001	1	2	110		01			1	30		90				2							30		31	0.33	10.00		30.00																																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	0.83	25.00																																												25.00				0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	5	1	Preferred Generic	3	4	001000	3	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	009	0	1	01	01	H5471_009_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	009	0	1	01	01	H5471_009_0	6	1	Preferred Generic	1	4	001000	3	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	6	3	Preferred Brand	1	4	000001	1	2	110		01			1	30		90				2							30		31	0.33	10.00		30.00																																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	6	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	0.83	25.00																																												25.00				0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	6	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	6	1	Preferred Generic	3	4	001000	3	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	010	0	1	01	01	H5471_010_0	3	1	Preferred Generic	1	4	001000	3	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	010	0	1	01	01	H5471_010_0	3	1	Preferred Generic	3	4	001000	3	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	010	0	1	01	01	H5471_010_0	3	3	Preferred Brand	1	4	000001	1	2	110		01			1	30		90				2							30		31	1.50	45.00		135.00																																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	010	0	1	01	01	H5471_010_0	3	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	3.00	90.00																																												90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	010	0	1	01	01	H5471_010_0	3	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	010	0	1	01	01	H5471_010_0	3	2	Non-Preferred Generic	1	4	000100	1	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	010	0	1	01	01	H5471_010_0	3	2	Non-Preferred Generic	3	4	000100	1	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	011	0	1	01	01	H5471_011_0	3	2	Non-Preferred Generic	3	4	000100	1	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	011	0	1	01	01	H5471_011_0	3	1	Preferred Generic	1	4	001000	3	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	011	0	1	01	01	H5471_011_0	3	2	Non-Preferred Generic	1	4	000100	1	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	011	0	1	01	01	H5471_011_0	3	3	Preferred Brand	1	4	000001	1	2	110		01			1	30		90				2							30		31	1.50	45.00		135.00																																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	011	0	1	01	01	H5471_011_0	3	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	3.00	90.00																																												90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	011	0	1	01	01	H5471_011_0	3	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	011	0	1	01	01	H5471_011_0	3	1	Preferred Generic	3	4	001000	3	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	012	0	1	01	01	H5471_012_0	4	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	012	0	1	01	01	H5471_012_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	0.50	15.00																																												15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	4	4	Non-Preferred Brand	3	4	100000	1	2	010		01			1	30													30		31	0.50	15.00																																												15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	012	0	1	01	01	H5471_012_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	012	0	1	01	01	H5471_012_0	4	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	013	0	1	01	01	H5471_013_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	013	0	1	01	01	H5471_013_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	013	0	1	01	01	H5471_013_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	013	0	1	01	01	H5471_013_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	2.50	75.00																																												75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	013	0	1	01	01	H5471_013_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	013	0	1	01	01	H5471_013_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	013	0	1	01	01	H5471_013_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	014	0	1	01	01	H5471_014_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	014	0	1	01	01	H5471_014_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		15.00																								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	014	0	1	01	01	H5471_014_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	014	0	1	01	01	H5471_014_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	1.00	30.00																																												30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	014	0	1	01	01	H5471_014_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	014	0	1	01	01	H5471_014_0	4	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	014	0	1	01	01	H5471_014_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	015	0	1	02	01	H5471_015_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	015	0	1	02	01	H5471_015_0	6	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	015	0	1	02	01	H5471_015_0	6	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	015	0	1	02	01	H5471_015_0	6	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	1.33	40.00																																												40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	015	0	1	02	01	H5471_015_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.67	20.00		60.00																								60.00																		20.00				0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	015	0	1	02	01	H5471_015_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	015	0	1	02	01	H5471_015_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	016	0	1	01	01	H5471_016_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	016	0	1	01	01	H5471_016_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	016	0	1	01	01	H5471_016_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	016	0	1	01	01	H5471_016_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	2.50	75.00																																												75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	016	0	1	01	01	H5471_016_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	017	0	1	01	01	H5471_017_0	3	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	0.83	25.00																																												25.00				0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	017	0	1	01	01	H5471_017_0	3	2	Non-Preferred Generic	1	4	000100	1	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	017	0	1	01	01	H5471_017_0	3	1	Preferred Generic	1	4	001000	3	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	017	0	1	01	01	H5471_017_0	3	3	Preferred Brand	1	4	000001	1	2	110		01			1	30		90				2							30		31	0.33	10.00		30.00																																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	017	0	1	01	01	H5471_017_0	3	2	Non-Preferred Generic	3	4	000100	1	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	017	0	1	01	01	H5471_017_0	3	1	Preferred Generic	3	4	001000	3	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	017	0	1	01	01	H5471_017_0	3	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	018	0	1	01	01	H5471_018_0	3	1	Preferred Generic	1	4	001000	3	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	018	0	1	01	01	H5471_018_0	3	2	Non-Preferred Generic	1	4	000100	1	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	018	0	1	01	01	H5471_018_0	3	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	018	0	1	01	01	H5471_018_0	3	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	0.83	25.00																																												25.00				0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	018	0	1	01	01	H5471_018_0	3	3	Preferred Brand	1	4	000001	1	2	110		01			1	30		90				2							30		31	0.33	10.00		30.00																																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	018	0	1	01	01	H5471_018_0	3	1	Preferred Generic	3	4	001000	3	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	018	0	1	01	01	H5471_018_0	3	2	Non-Preferred Generic	3	4	000100	1	2	110		01			1	30		90				2							30		31	0.00	0.00		0.00																																										0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	019	0	1	01	01	H5471_019_0	4	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	019	0	1	01	01	H5471_019_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	019	0	1	01	01	H5471_019_0	4	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		15.00																								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	019	0	1	01	01	H5471_019_0	4	4	Non-Preferred Brand	3	4	100000	1	2	010		01			1	30													30		31	1.00	30.00																																												30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	019	0	1	01	01	H5471_019_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	019	0	1	01	01	H5471_019_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	019	0	1	01	01	H5471_019_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		15.00																								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	019	0	1	01	01	H5471_019_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	1.00	30.00																																												30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	019	0	1	01	01	H5471_019_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	020	0	1	01	01	H5471_020_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	020	0	1	01	01	H5471_020_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	020	0	1	01	01	H5471_020_0	4	4	Non-Preferred Brand	3	4	100000	1	2	010		01			1	30													30		31	1.83	55.00																																												55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	020	0	1	01	01	H5471_020_0	4	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.67	20.00		60.00																								60.00																		20.00				0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	020	0	1	01	01	H5471_020_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	020	0	1	01	01	H5471_020_0	4	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	020	0	1	01	01	H5471_020_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	020	0	1	01	01	H5471_020_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	1.83	55.00																																												55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	020	0	1	01	01	H5471_020_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.67	20.00		60.00																								60.00																		20.00				0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	1.83	55.00																																												55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.67	20.00		60.00																								60.00																		20.00				0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	4	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	021	0	1	01	01	H5471_021_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	022	0	1	01	01	H5471_022_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	3.17	95.00																																												95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	022	0	1	01	01	H5471_022_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	022	0	1	01	01	H5471_022_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	022	0	1	01	01	H5471_022_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.83	25.00		75.00																								75.00																		25.00				0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	022	0	1	01	01	H5471_022_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.07	2.00		6.00																								6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	024	0	1	01	01	H5471_024_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	024	0	1	01	01	H5471_024_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.83	25.00		75.00																								75.00																		25.00				0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	024	0	1	01	01	H5471_024_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	024	0	1	01	01	H5471_024_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.07	2.00		6.00																								6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	024	0	1	01	01	H5471_024_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	3.17	95.00																																												95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	025	0	1	01	01	H5471_025_0	5	2	Preferred Brand	1	4	000001	1	1	010		01			1	30													30		31					95.34	25																																										25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	025	0	1	01	01	H5471_025_0	5	3	Non-Preferred Brand	1	4	100000	1	1	010		01			1	30													30		31					162.52	25																																										25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	025	0	1	01	01	H5471_025_0	5	4	Specialty Tier	1	4	110001	1	1	010		01			1	30													30		31					1.00	25																																										25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	025	0	1	01	01	H5471_025_0	5	1	Generic	1	4	010000	3	1	010		01			1	30													30		31					6.68	25																																										25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	027	0	1	01	01	H5471_027_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	027	0	1	01	01	H5471_027_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	027	0	1	01	01	H5471_027_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	027	0	1	01	01	H5471_027_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	027	0	1	01	01	H5471_027_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	027	0	1	01	01	H5471_027_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	027	0	1	01	01	H5471_027_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	3.17	95.00																																												95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	028	0	1	01	01	H5471_028_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	028	0	1	01	01	H5471_028_0	4	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	028	0	1	01	01	H5471_028_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	2.17	65.00																																												65.00				2.10	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	028	0	1	01	01	H5471_028_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	028	0	1	01	01	H5471_028_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		90.00																								90.00																		30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	028	0	1	01	01	H5471_028_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	028	0	1	01	01	H5471_028_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	029	0	1	01	01	H5471_029_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.17	35.00		105.00																								105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	029	0	1	01	01	H5471_029_0	4	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		15.00																								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	029	0	1	01	01	H5471_029_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	3.17	95.00																																												95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	029	0	1	01	01	H5471_029_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	029	0	1	01	01	H5471_029_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.33	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	029	0	1	01	01	H5471_029_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		15.00																								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	030	0	1	01	01	H5471_030_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	030	0	1	01	01	H5471_030_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	030	0	1	01	01	H5471_030_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		90.00																								90.00																		30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	030	0	1	01	01	H5471_030_0	6	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	2.17	65.00																																												65.00				2.10	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	030	0	1	01	01	H5471_030_0	6	4	Non-Preferred Brand	3	4	100000	1	2	010		01			1	30													30		31	2.17	65.00																																												65.00				2.10	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	030	0	1	01	01	H5471_030_0	6	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	030	0	1	01	01	H5471_030_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	030	0	1	01	01	H5471_030_0	6	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		90.00																								90.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	030	0	1	01	01	H5471_030_0	6	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	032	0	1	01	01	H5471_032_0	7	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	032	0	1	01	01	H5471_032_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	032	0	1	01	01	H5471_032_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	032	0	1	01	01	H5471_032_0	7	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	032	0	1	01	01	H5471_032_0	7	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	032	0	1	01	01	H5471_032_0	7	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	3.17	95.00																																												95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	032	0	1	01	01	H5471_032_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	033	0	1	02	01	H5471_033_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	033	0	1	02	01	H5471_033_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.27	8.00		8.00																								24.00																		8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	033	0	1	02	01	H5471_033_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	033	0	1	02	01	H5471_033_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	2.83	85.00																																												85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	033	0	1	02	01	H5471_033_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	034	0	1	02	01	H5471_034_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	034	0	1	02	01	H5471_034_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.27	8.00		24.00																								24.00																		8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	034	0	1	02	01	H5471_034_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	034	0	1	02	01	H5471_034_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	2.83	85.00																																												85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	034	0	1	02	01	H5471_034_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	034	0	1	02	01	H5471_034_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	034	0	1	02	01	H5471_034_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.27	8.00		24.00																								24.00																		8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	034	0	1	02	01	H5471_034_0	5	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	034	0	1	02	01	H5471_034_0	5	4	Non-Preferred Brand	3	4	100000	1	2	010		01			1	30													30		31	2.83	85.00																																												85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	039	0	1	01	01	H5471_039_0	7	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	039	0	1	01	01	H5471_039_0	7	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	3.17	95.00																																												95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	039	0	1	01	01	H5471_039_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	039	0	1	01	01	H5471_039_0	7	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	039	0	1	01	01	H5471_039_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	039	0	1	01	01	H5471_039_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	039	0	1	01	01	H5471_039_0	7	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	042	0	1	01	01	H5471_042_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	042	0	1	01	01	H5471_042_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	042	0	1	01	01	H5471_042_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	042	0	1	01	01	H5471_042_0	4	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.83	25.00		75.00																								75.00																		25.00				0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	042	0	1	01	01	H5471_042_0	4	4	Non-Preferred Brand	3	4	100000	1	2	010		01			1	30													30		31	2.50	75.00																																												75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	042	0	1	01	01	H5471_042_0	4	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	042	0	1	01	01	H5471_042_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	042	0	1	01	01	H5471_042_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.83	25.00		75.00																								75.00																		25.00				.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	042	0	1	01	01	H5471_042_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	2.50	75.00																																												75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	043	0	1	01	01	H5471_043_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	043	0	1	01	01	H5471_043_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	043	0	1	01	01	H5471_043_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	043	0	1	01	01	H5471_043_0	4	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	043	0	1	01	01	H5471_043_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	043	0	1	01	01	H5471_043_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.83	25.00		75.00																								75.00																		25.00				0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	043	0	1	01	01	H5471_043_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	2.50	75.00																																												75.00				2.42	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	044	0	1	01	01	H5471_044_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	3.17	95.00																																												95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	044	0	1	01	01	H5471_044_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.17	35.00		105.00																								105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	044	0	1	01	01	H5471_044_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.33	10.00		30.00																								30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	044	0	1	01	01	H5471_044_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	044	0	1	01	01	H5471_044_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.10	3.00		9.00																								9.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	045	0	1	01	01	H5471_045_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		15.00																								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	045	0	1	01	01	H5471_045_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	045	0	1	01	01	H5471_045_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	2.83	85.00																																												85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	045	0	1	01	01	H5471_045_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	045	0	1	01	01	H5471_045_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.33	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	045	0	1	01	01	H5471_045_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	046	0	1	01	01	H5471_046_0	4	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	046	0	1	01	01	H5471_046_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	046	0	1	01	01	H5471_046_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.50	15.00		45.00																								45.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	046	0	1	01	01	H5471_046_0	4	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	046	0	1	01	01	H5471_046_0	4	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	2.83	85.00																																												85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	002	0	1	01	01	H5475_002_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	002	0	1	01	01	H5475_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	.16	5.00		15.00																								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	002	0	1	01	01	H5475_002_0	7	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	31		90				2			90				31		31						25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	002	0	1	01	01	H5475_002_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.74	85.00		255.00																								255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	002	0	1	01	01	H5475_002_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.45	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5507	001	0	1	04	01	H5507_001_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5507	001	0	1	04	01	H5507_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.23	7.00		21.00																															14.00							21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5507	001	0	1	04	01	H5507_001_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5507	001	0	1	04	01	H5507_001_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					622.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5507	001	0	1	04	01	H5507_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	001	0	1	04	01	H5508_001_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5508	001	0	1	04	01	H5508_001_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5508	001	0	1	04	01	H5508_001_0	10	5	Specialty Tier	1	4	000010	1	1	110		01	110		1	30		90				2	30		90				30		31					33.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	001	0	1	04	01	H5508_001_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	2.90	90.00		270.00																					2.90	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	001	0	1	04	01	H5508_001_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	001	0	1	04	01	H5508_001_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	001	0	1	04	01	H5508_001_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	005	0	1	04	01	H5508_005_0	14	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	005	0	1	04	01	H5508_005_0	14	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	005	0	1	04	01	H5508_005_0	14	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	005	0	1	04	01	H5508_005_0	14	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5508	005	0	1	04	01	H5508_005_0	14	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5508	005	0	1	04	01	H5508_005_0	14	5	Specialty Tier	1	4	000010	1	1	110		01	110		1	30		90				2	30		90				30		31					33.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	005	0	1	04	01	H5508_005_0	14	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	2.90	90.00		270.00																					2.90	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	006	0	1	04	01	H5508_006_0	13	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5508	006	0	1	04	01	H5508_006_0	13	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5508	006	0	1	04	01	H5508_006_0	13	5	Specialty Tier	1	4	000010	1	1	110		01	110		1	30		90				2	30		90				30		31					33.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	006	0	1	04	01	H5508_006_0	13	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	006	0	1	04	01	H5508_006_0	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	006	0	1	04	01	H5508_006_0	13	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	006	0	1	04	01	H5508_006_0	13	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	2.90	90.00		270.00																					2.90	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	001	0	1	04	01	H5509_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	001	0	1	04	01	H5509_001_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	001	0	1	04	01	H5509_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					1.10	33.00	66.00	99.00					.33	10.00	20.00	30.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	001	0	1	04	01	H5509_001_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.23	7.00	14.00	21.00					.33	10.00	20.00	30.00					.23	7.00	14.00	17.50																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	001	0	1	04	01	H5509_001_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	003	0	1	04	01	H5509_003_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	003	0	1	04	01	H5509_003_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	003	0	1	04	01	H5509_003_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					1.10	33.00	66.00	99.00					.33	10.00	20.00	30.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	003	0	1	04	01	H5509_003_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.23	7.00	14.00	21.00					.33	10.00	20.00	30.00					.23	7.00	0.00	0.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	003	0	1	04	01	H5509_003_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	010	0	1	04	01	H5509_010_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.16	5.00	10.00	15.00					.26	8.00	16.00	24.00					.16	5.00	10.00	12.50																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	010	0	1	04	01	H5509_010_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					.50	15.00	30.00	45.00					.33	10.00	20.00	30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	010	0	1	04	01	H5509_010_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	010	0	1	04	01	H5509_010_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	010	0	1	04	01	H5509_010_0	5	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	011	0	1	04	01	H5509_011_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	011	0	1	04	01	H5509_011_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	011	0	1	04	01	H5509_011_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					.50	15.00	30.00	45.00					.33	10.00	20.00	30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	011	0	1	04	01	H5509_011_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.20	6.00	12.00	18.00					.30	9.00	18.00	27.00					.20	6.00	12.00	15.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	011	0	1	04	01	H5509_011_0	5	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	012	0	1	04	01	H5509_012_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					1.10	33.00	66.00	99.00					.33	10.00	20.00	30.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	012	0	1	04	01	H5509_012_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.23	7.00	14.00	21.00					.33	10.00	20.00	30.00					.23	7.00	14.00	17.50																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	012	0	1	04	01	H5509_012_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	012	0	1	04	01	H5509_012_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	012	0	1	04	01	H5509_012_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	016	0	1	04	01	H5509_016_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					.50	15.00	30.00	45.00					.33	10.00	20.00	30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	016	0	1	04	01	H5509_016_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.16	5.00	10.00	15.00					.26	8.00	16.00	24.00					.16	5.00	10.00	12.50																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	016	0	1	04	01	H5509_016_0	4	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	016	0	1	04	01	H5509_016_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	016	0	1	04	01	H5509_016_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	017	0	1	04	01	H5509_017_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.20	6.00	12.00	18.00					.30	9.00	18.00	27.00					.20	6.00	0.00	0.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	017	0	1	04	01	H5509_017_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					1.10	33.00	66.00	99.00					.33	10.00	20.00	30.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	017	0	1	04	01	H5509_017_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	017	0	1	04	01	H5509_017_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	017	0	1	04	01	H5509_017_0	5	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	018	0	1	04	01	H5509_018_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	018	0	1	04	01	H5509_018_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	018	0	1	04	01	H5509_018_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.13	4.00	8.00	12.00					.23	7.00	14.00	21.00					.13	4.00	0.00	0.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	018	0	1	04	01	H5509_018_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					1.10	33.00	66.00	99.00					.33	10.00	20.00	30.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	018	0	1	04	01	H5509_018_0	4	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	019	0	1	04	01	H5509_019_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.10	3.00	6.00	9.00					.20	6.00	12.00	18.00					.10	3.00	6.00	7.50																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	019	0	1	04	01	H5509_019_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	30.00					1.10	33.00	66.00	99.00					.33	10.00	20.00	30.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	019	0	1	04	01	H5509_019_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	019	0	1	04	01	H5509_019_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5509	019	0	1	04	01	H5509_019_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5516	001	0	1	04	01	H5516_001_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.10	3.00		9.00																															6.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5516	001	0	1	04	01	H5516_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.20	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5516	001	0	1	04	01	H5516_001_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					640.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5516	001	0	1	04	01	H5516_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5516	001	0	1	04	01	H5516_001_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5520	002	0	1	04	01	H5520_002_0	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					323.52	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	238.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.40	42.00	84.00	126.00																												1.40	42.00	84.00	84.00				1.40	42.00	84.00	126.00				42.00				1.23	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	20.00				0.33	10.00	20.00	30.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.16	5.00	10.00	15.00																												0.16	5.00	10.00	10.00				0.16	5.00	10.00	15.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					145.63	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	238.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.40	42.00	84.00	126.00																												1.40	42.00	84.00	84.00				1.40	42.00	84.00	126.00				42.00				1.23	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	20.00				0.33	10.00	20.00	30.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.16	5.00	10.00	15.00																												0.16	5.00	10.00	10.00				0.16	5.00	10.00	15.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	006	0	1	04	01	H5520_006_0	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.23	7.00	14.00	21.00																												0.23	7.00	14.00	14.00				0.23	7.00	14.00	21.00				7.00				0.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	006	0	1	04	01	H5520_006_0	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					239.60	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	006	0	1	04	01	H5520_006_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	238.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	006	0	1	04	01	H5520_006_0	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	006	0	1	04	01	H5520_006_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	006	0	1	04	01	H5520_006_0	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	009	0	1	04	01	H5520_009_0	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.16	5.00	10.00	15.00																												0.16	5.00	10.00	10.00				0.16	5.00	10.00	15.00				5.00				0.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	009	0	1	04	01	H5520_009_0	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	009	0	1	04	01	H5520_009_0	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					362.43	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	009	0	1	04	01	H5520_009_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	238.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	009	0	1	04	01	H5520_009_0	5	3	Preferred Brand	1	4	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.16	35.00	70.00	105.00																												1.16	35.00	70.00	70.00				1.16	35.00	70.00	105.00				35.00				1.02	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	009	0	1	04	01	H5520_009_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.26	8.00	16.00	24.00																												0.26	8.00	16.00	16.00				0.26	8.00	16.00	24.00				8.00				0.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					319.32	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	238.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.23	7.00	14.00	21.00																												0.23	7.00	14.00	14.00				0.23	7.00	14.00	21.00				7.00				0.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	5	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	5	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					319.32	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	238.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	5	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	5	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.23	7.00	14.00	21.00																												0.23	7.00	14.00	14.00				0.23	7.00	14.00	21.00				7.00				0.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	6	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.23	7.00	14.00	21.00																												0.23	7.00	14.00	14.00				0.23	7.00	14.00	21.00				7.00				0.20	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.50	15.00	30.00	45.00																												0.50	15.00	30.00	30.00				0.50	15.00	30.00	45.00				15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	6	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	238.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	6	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					319.32	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	6	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	012	0	1	04	01	H5521_012_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	012	0	1	04	01	H5521_012_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	012	0	1	04	01	H5521_012_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	012	0	1	04	01	H5521_012_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	012	0	1	04	01	H5521_012_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	012	0	1	04	01	H5521_012_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5521	013	0	1	04	01	H5521_013_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	013	0	1	04	01	H5521_013_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	013	0	1	04	01	H5521_013_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	013	0	1	04	01	H5521_013_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5521	013	0	1	04	01	H5521_013_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	013	0	1	04	01	H5521_013_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	015	0	1	04	01	H5521_015_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	015	0	1	04	01	H5521_015_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	015	0	1	04	01	H5521_015_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	015	0	1	04	01	H5521_015_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	015	0	1	04	01	H5521_015_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	015	0	1	04	01	H5521_015_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5521	016	0	1	04	01	H5521_016_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	016	0	1	04	01	H5521_016_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	016	0	1	04	01	H5521_016_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					74.24	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	016	0	1	04	01	H5521_016_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					37.44	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	016	0	1	04	01	H5521_016_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	016	0	1	04	01	H5521_016_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5521	020	0	1	04	01	H5521_020_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	020	0	1	04	01	H5521_020_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	020	0	1	04	01	H5521_020_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					74.72	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	020	0	1	04	01	H5521_020_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					38.09	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	020	0	1	04	01	H5521_020_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	020	0	1	04	01	H5521_020_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5521	022	0	1	04	01	H5521_022_0	6	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	022	0	1	04	01	H5521_022_0	6	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	022	0	1	04	01	H5521_022_0	6	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					81.88	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	022	0	1	04	01	H5521_022_0	6	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.18	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	022	0	1	04	01	H5521_022_0	6	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	022	0	1	04	01	H5521_022_0	6	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5521	027	0	1	04	01	H5521_027_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	027	0	1	04	01	H5521_027_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	027	0	1	04	01	H5521_027_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	027	0	1	04	01	H5521_027_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	027	0	1	04	01	H5521_027_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	027	0	1	04	01	H5521_027_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5521	028	0	1	04	01	H5521_028_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	028	0	1	04	01	H5521_028_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					35.09	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	028	0	1	04	01	H5521_028_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					76.55	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	028	0	1	04	01	H5521_028_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	028	0	1	04	01	H5521_028_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	028	0	1	04	01	H5521_028_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5521	033	0	1	04	01	H5521_033_0	5	1	Generic	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.13	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	033	0	1	04	01	H5521_033_0	5	2	Preferred Brand	1	3	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	033	0	1	04	01	H5521_033_0	5	3	Non-Preferred Brand	1	3	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	033	0	1	04	01	H5521_033_0	5	4	Specialty Tier	1	3	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	033	0	1	04	01	H5521_033_0	5	5	Select Care Drugs	1	3	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.13	4.00	8.00	12.00					4.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	037	0	1	04	01	H5521_037_0	6	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	037	0	1	04	01	H5521_037_0	6	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	037	0	1	04	01	H5521_037_0	6	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	037	0	1	04	01	H5521_037_0	6	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5521	037	0	1	04	01	H5521_037_0	6	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	037	0	1	04	01	H5521_037_0	6	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	038	0	1	04	01	H5521_038_0	6	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5521	038	0	1	04	01	H5521_038_0	6	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	038	0	1	04	01	H5521_038_0	6	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	038	0	1	04	01	H5521_038_0	6	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	038	0	1	04	01	H5521_038_0	6	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	038	0	1	04	01	H5521_038_0	6	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	040	0	1	04	01	H5521_040_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	040	0	1	04	01	H5521_040_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	040	0	1	04	01	H5521_040_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	040	0	1	04	01	H5521_040_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5521	040	0	1	04	01	H5521_040_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	040	0	1	04	01	H5521_040_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.20	6.00	12.00	18.00					6.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5522	001	0	1	04	01	H5522_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.63	19.00	38.00	57.00					1.00	30.00	60.00	90.00					0.63	19.00	38.00	47.50																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.26	8.00	16.00	24.00					0.16	5.00	10.00	12.50																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.13	34.00	68.00	102.00					1.50	45.00	90.00	135.00					1.13	34.00	68.00	85.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	7	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.26	8.00	16.00	24.00					0.16	5.00	10.00	12.50																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5522	001	0	1	04	01	H5522_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	180.00	270.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.06	2.00	4.00	6.00					0.16	5.00	10.00	15.00					0.06	2.00	4.00	5.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5522	002	0	1	04	01	H5522_002_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.06	2.00	4.00	6.00					0.16	5.00	10.00	15.00					0.06	2.00	4.00	5.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.50	15.00	30.00	45.00					0.90	27.00	54.00	81.00					0.50	15.00	30.00	37.50																		27.00				0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	180.00	270.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	80.00	100.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.66	80.00	160.00	240.00					3.16	95.00	190.00	285.00					2.66	80.00	160.00	240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.10	33.00	66.00	99.00					0.66	20.00	40.00	50.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.20	6.00	12.00	18.00					0.33	10.00	20.00	30.00					0.20	6.00	12.00	15.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.73	22.00	44.00	66.00					1.06	32.00	64.00	96.00					0.73	22.00	44.00	55.00																		32.00				1.03	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	180.00	270.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.23	7.00	14.00	21.00					0.13	4.00	8.00	10.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	008	0	1	04	01	H5522_008_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.30	9.00	18.00	27.00					0.16	5.00	10.00	12.50																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	008	0	1	04	01	H5522_008_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.63	19.00	38.00	57.00					1.10	33.00	66.00	99.00					0.63	19.00	38.00	47.50																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	008	0	1	04	01	H5522_008_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00					1.23	37.00	74.00	92.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	008	0	1	04	01	H5522_008_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	008	0	1	04	01	H5522_008_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	009	0	1	04	01	H5522_009_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.26	8.00	16.00	24.00					0.16	5.00	10.00	12.50																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	009	0	1	04	01	H5522_009_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.63	19.00	38.00	57.00					1.00	30.00	60.00	90.00					0.63	19.00	38.00	47.50																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	009	0	1	04	01	H5522_009_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00					1.23	37.00	74.00	92.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	009	0	1	04	01	H5522_009_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	009	0	1	04	01	H5522_009_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.20	6.00	12.00	18.00					0.33	10.00	20.00	30.00					0.20	6.00	12.00	15.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.10	33.00	66.00	99.00					0.66	20.00	40.00	50.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.20	6.00	12.00	18.00					0.33	10.00	20.00	30.00					0.20	6.00	12.00	15.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.10	33.00	66.00	99.00					0.66	20.00	40.00	50.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.26	38.00	76.00	114.00					1.50	45.00	90.00	135.00					1.26	38.00	76.00	95.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	015	0	1	04	01	H5522_015_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.20	6.00	12.00	18.00					0.33	10.00	20.00	30.00					0.20	6.00	12.00	15.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	015	0	1	04	01	H5522_015_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.10	33.00	66.00	99.00					0.66	20.00	40.00	50.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	015	0	1	04	01	H5522_015_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.26	38.00	76.00	114.00					1.50	45.00	90.00	135.00					1.26	38.00	76.00	95.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	015	0	1	04	01	H5522_015_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	015	0	1	04	01	H5522_015_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	004	0	1	04	01	H5525_004_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	004	0	1	04	01	H5525_004_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	004	0	1	04	01	H5525_004_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5525	004	0	1	04	01	H5525_004_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	004	0	1	04	01	H5525_004_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	005	0	1	04	01	H5525_005_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	005	0	1	04	01	H5525_005_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	005	0	1	04	01	H5525_005_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5525	005	0	1	04	01	H5525_005_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	006	0	1	04	01	H5525_006_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	006	0	1	04	01	H5525_006_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	006	0	1	04	01	H5525_006_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	006	0	1	04	01	H5525_006_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	006	0	1	04	01	H5525_006_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5525	006	0	1	04	01	H5525_006_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	007	0	1	04	01	H5525_007_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	007	0	1	04	01	H5525_007_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	007	0	1	04	01	H5525_007_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	007	0	1	04	01	H5525_007_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5526	004	0	1	04	01	H5526_004_0	6	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	.09	3.00		9.00																					0.09	3.00		7.50																			3.00			0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.38	12.00		36.00																					0.38	12.00		30.00																			12.00			0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	31	1.45	45.00		135.00																					1.45	45.00		112.50																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6	4	Non-Preferred Brand	1	4	100000	1	1	110		10	110		1	30		90				2	30		90					29	31					56.52	50		50																					50		42																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					1.00	30		30																					30		25																		30			30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	014	0	1	04	01	H5526_014_0	5	1	Preferred Generic	1	4	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	0.16	5.00		15.00																					0.16	5.00		12.50																			5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	014	0	1	04	01	H5526_014_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	0.38	12.00		36.00																					0.38	12.00		30.00																			12.00			0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	014	0	1	04	01	H5526_014_0	5	3	Preferred Brand	1	4	000001	1	2	110		10	110		1	30		90				2	30		90					29	31	1.45	45.00		135.00																					1.45	45.00		112.50																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	014	0	1	04	01	H5526_014_0	5	4	Non-Preferred Brand	1	4	100000	1	1	110		10	110		1	30		90				2	30		90					29	31					56.60	50		50																					50		42																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	014	0	1	04	01	H5526_014_0	5	5	Specialty Tier	1	4	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					1.00	30		30																					30		25																		30			30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	002	0	1	04	01	H5528_002_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	002	0	1	04	01	H5528_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	002	0	1	04	01	H5528_002_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					949.16	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	002	0	1	04	01	H5528_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	002	0	1	04	01	H5528_002_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	003	0	1	04	01	H5528_003_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	003	0	1	04	01	H5528_003_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	003	0	1	04	01	H5528_003_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	003	0	1	04	01	H5528_003_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	003	0	1	04	01	H5528_003_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					872.33	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	003	0	1	04	01	H5528_003_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.07	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5528	003	0	1	04	01	H5528_003_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.33	10.00	20.00	30.00																		10.00				.33	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5528	005	0	1	04	01	H5528_005_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	005	0	1	04	01	H5528_005_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	005	0	1	04	01	H5528_005_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	005	0	1	04	01	H5528_005_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	005	0	1	04	01	H5528_005_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					710.22	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	008	0	1	04	01	H5528_008_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	008	0	1	04	01	H5528_008_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	008	0	1	04	01	H5528_008_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	008	0	1	04	01	H5528_008_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	008	0	1	04	01	H5528_008_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.33	10.00	20.00	30.00																		10.00				.33	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5528	008	0	1	04	01	H5528_008_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.07	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5528	008	0	1	04	01	H5528_008_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					924.52	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	010	0	1	04	01	H5528_010_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	010	0	1	04	01	H5528_010_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	010	0	1	04	01	H5528_010_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	010	0	1	04	01	H5528_010_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	010	0	1	04	01	H5528_010_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					899.86	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	011	0	1	04	01	H5528_011_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.17	35.00	70.00	105.00																					1.17	35.00	70.00	105.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	011	0	1	04	01	H5528_011_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	011	0	1	04	01	H5528_011_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	011	0	1	04	01	H5528_011_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	3.17	95.00	190.00	285.00																					3.17	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	011	0	1	04	01	H5528_011_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.33	10.00	20.00	30.00																					.33	10.00	20.00	30.00																		10.00				.33	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5528	011	0	1	04	01	H5528_011_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.07	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5528	011	0	1	04	01	H5528_011_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					879.79	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	018	0	1	04	01	H5528_018_0	6	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.07	2.00	4.00	6.00																					.07	2.00	4.00	6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	018	0	1	04	01	H5528_018_0	6	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					827.68	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	018	0	1	04	01	H5528_018_0	6	4	Non-Preferred Brand	1	2	100000	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					78.00	30	30	30																					30	30	30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	018	0	1	04	01	H5528_018_0	6	3	Preferred Brand	1	2	000001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					53.42	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	018	0	1	04	01	H5528_018_0	6	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.30	9.00	18.00	27.00																					.30	9.00	18.00	27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5529	001	0	1	04	01	H5529_001_0	6	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5529	001	0	1	04	01	H5529_001_0	6	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													70.00	33	33	33					70.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5529	001	0	1	04	01	H5529_001_0	6	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.12	4.00	8.00	12.00					0.26	9.00	18.00	27.00					0.12	4.00	8.00	8.00																		9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5529	001	0	1	04	01	H5529_001_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.41	14.00	28.00	42.00					0.56	19.00	38.00	57.00					0.41	14.00	28.00	28.00																		19.00				0.56	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5529	001	0	1	04	01	H5529_001_0	6	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5529	001	0	1	04	01	H5529_001_0	6	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5529	004	0	1	04	01	H5529_004_0	7	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5529	004	0	1	04	01	H5529_004_0	7	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													67.00	33	33	33					67.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5529	004	0	1	04	01	H5529_004_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5529	004	0	1	04	01	H5529_004_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5529	004	0	1	04	01	H5529_004_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.24	8.00	16.00	24.00					0.38	13.00	26.00	39.00					0.24	8.00	16.00	16.00																		13.00				0.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5529	004	0	1	04	01	H5529_004_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.09	3.00	6.00	9.00					0.24	8.00	16.00	24.00					0.09	3.00	6.00	6.00																		8.00				0.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5530	001	0	1	04	01	H5530_001_0	7	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.12	4.00	8.00	12.00					.26	9.00	18.00	27.00					.12	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5530	001	0	1	04	01	H5530_001_0	7	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.47	16.00	32.00	48.00					.62	21.00	42.00	63.00					.47	16.00	32.00	32.00																		21.00				.62	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5530	001	0	1	04	01	H5530_001_0	7	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5530	001	0	1	04	01	H5530_001_0	7	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5530	001	0	1	04	01	H5530_001_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5530	001	0	1	04	01	H5530_001_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5532	001	0	1	04	01	H5532_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					561.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5532	001	0	1	04	01	H5532_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5532	001	0	1	04	01	H5532_001_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5532	001	0	1	04	01	H5532_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5532	001	0	1	04	01	H5532_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5533	003	0	1	04	01	H5533_003_0	13	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	31							31						31		31					760.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	13	3	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	13	5	Select Care Drugs	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	13	1	Generic	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	13	2	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	7	2	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	7	3	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	7	5	Select Care Drugs	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	7	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	31							31						31		31					760.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	7	1	Generic	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	006	0	1	04	01	H5533_006_0	9	5	Select Care Drugs	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	006	0	1	04	01	H5533_006_0	9	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	31							31						31		31					760.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	006	0	1	04	01	H5533_006_0	9	2	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	006	0	1	04	01	H5533_006_0	9	1	Generic	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	006	0	1	04	01	H5533_006_0	9	3	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5549	004	0	1	01	01	H5549_004_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	004	0	1	01	01	H5549_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	004	0	1	01	01	H5549_004_0	6	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31					400.11	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	004	0	1	01	01	H5549_004_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.00	90.00		270.00																								225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	004	0	1	01	01	H5549_004_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.00	30.00		90.00																								75.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	006	0	1	02	01	H5576_006_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					.09	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	006	0	1	02	01	H5576_006_0	8	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.32	10.00	20.00	30.00																					0.32	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	006	0	1	02	01	H5576_006_0	8	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					.09	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	006	0	1	02	01	H5576_006_0	8	5	Specialty Tier	1	4	100000	1	1	010		01	010		1	31							31						31		31					658.26	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	006	0	1	02	01	H5576_006_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	006	0	1	02	01	H5576_006_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	006	0	1	02	01	H5576_006_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.32	10.00	20.00	30.00																					.32	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	007	0	1	02	01	H5576_007_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	007	0	1	02	01	H5576_007_0	8	5	Specialty Tier	1	4	100000	1	1	010		01	010		1	31							31						31		31					876.59	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	007	0	1	02	01	H5576_007_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	007	0	1	02	01	H5576_007_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.32	10.00	20.00	30.00																					.32	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	007	0	1	02	01	H5576_007_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					.09	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	009	0	1	02	01	H5576_009_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					.09	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	009	0	1	02	01	H5576_009_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.32	10.00	20.00	30.00																					.32	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	009	0	1	02	01	H5576_009_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	009	0	1	02	01	H5576_009_0	9	5	Specialty Tier	1	4	100000	1	1	010		01	010		1	31							31						31		31					894.88	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	009	0	1	02	01	H5576_009_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	012	0	1	02	01	H5576_012_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					.09	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	012	0	1	02	01	H5576_012_0	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.32	10.00	20.00	30.00																					.32	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	012	0	1	02	01	H5576_012_0	8	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					.09	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	012	0	1	02	01	H5576_012_0	8	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.32	10.00	20.00	30.00																					.32	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	012	0	1	02	01	H5576_012_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	012	0	1	02	01	H5576_012_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	012	0	1	02	01	H5576_012_0	8	5	Specialty Tier	1	4	100000	1	1	010		01	010		1	31							31						31		31					500.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.13	4.00		12.00																					0.13	4.00		8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.17	5.00		15.00																					0.17	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	12	3	Preferred Brand	1	4	000001	3	2	110		01	110		1	30		90				1	30		90				30		31	0.97	29.00		87.00																					0.97	29.00		58.00																		29.00				0.94	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	1.67	50.00		150.00																					1.67	50.00		100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	12	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	30							30						30		31					809.48	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	12	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.13	4.00		12.00																					0.13	4.00		8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5577	005	0	1	01	01	H5577_005_0	12	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.17	5.00		15.00																					0.17	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5577	008	0	1	02	01	H5577_008_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.13	4.00		12.00																					0.13	4.00		8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	008	0	1	02	01	H5577_008_0	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.17	5.00		15.00																					0.17	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	008	0	1	02	01	H5577_008_0	12	3	Preferred Brand	1	4	000001	3	2	110		01	110		1	30		90				1	30		90				30		31	0.97	29.00		87.00																					0.97	29.00		58.00																		29.00				0.94	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	008	0	1	02	01	H5577_008_0	12	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.13	4.00		12.00																					0.13	4.00		8.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5577	008	0	1	02	01	H5577_008_0	12	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	30							30						30		31					809.48	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	008	0	1	02	01	H5577_008_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	1.67	50.00		150.00																					1.67	50.00		100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	008	0	1	02	01	H5577_008_0	12	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.17	5.00		15.00																					0.17	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5591	001	0	1	02	01	H5591_001_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.50	45.00	90.00	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	10	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.20	6.00	12.00	18.00					0.33	10.00	20.00	30.00					0.33	10.00	20.00	25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	10	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.00	0.00	0.00	0.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.00	90.00	180.00	270.00					3.00	90.00	180.00	270.00					3.00	90.00	180.00	225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	10	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													600.00	33	33	33					600.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	004	0	1	02	01	H5591_004_0	9	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.00	0.00	0.00	0.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	004	0	1	02	01	H5591_004_0	9	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.20	6.00	12.00	18.00					0.33	10.00	20.00	30.00					0.33	10.00	20.00	25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	004	0	1	02	01	H5591_004_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.50	45.00	90.00	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	004	0	1	02	01	H5591_004_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.00	90.00	180.00	270.00					3.00	90.00	180.00	270.00					3.00	90.00	180.00	225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	004	0	1	02	01	H5591_004_0	9	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													600.00	33	33	33					600.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	7	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.00	0.00	0.00	0.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	10.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	7	2	Non-Preferred Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.20	6.00	12.00	18.00					0.33	10.00	20.00	30.00					0.33	10.00	20.00	25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	7	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													600.00	33	33	33					600.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									3.00	90.00	180.00	270.00					3.00	90.00	180.00	270.00					3.00	90.00	180.00	225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.50	45.00	90.00	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	001	0	1	02	01	H5594_001_0	7	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	001	0	1	02	01	H5594_001_0	7	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	001	0	1	02	01	H5594_001_0	7	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		60.00																		30.00				0.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	001	0	1	02	01	H5594_001_0	7	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	002	0	1	02	01	H5594_002_0	6	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	0.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	002	0	1	02	01	H5594_002_0	6	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.30	69.00		207.00																					2.30	69.00		138.00																		69.00				2.22	69.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	002	0	1	02	01	H5594_002_0	6	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	002	0	1	02	01	H5594_002_0	6	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5594	002	0	1	02	01	H5594_002_0	6	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	018	0	1	02	01	H5594_018_0	7	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	018	0	1	02	01	H5594_018_0	7	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.16	35.00		105.00																					1.16	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	018	0	1	02	01	H5594_018_0	7	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	018	0	1	02	01	H5594_018_0	7	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	019	0	1	02	01	H5594_019_0	5	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	019	0	1	02	01	H5594_019_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	0.83	25.00		75.00																					0.83	25.00		50.00																		25.00				0.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	019	0	1	02	01	H5594_019_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	019	0	1	02	01	H5594_019_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	019	0	1	02	01	H5594_019_0	5	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5594	022	0	1	02	01	H5594_022_0	5	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	022	0	1	02	01	H5594_022_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.16	35.00		105.00																					1.16	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	022	0	1	02	01	H5594_022_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	022	0	1	02	01	H5594_022_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.30	69.00		207.00																					2.30	69.00		138.00																		69.00				2.22	69.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	026	0	1	02	01	H5594_026_0	7	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	026	0	1	02	01	H5594_026_0	7	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	026	0	1	02	01	H5594_026_0	7	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.16	35.00		105.00																					1.16	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	026	0	1	02	01	H5594_026_0	7	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	027	0	1	02	01	H5594_027_0	5	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	027	0	1	02	01	H5594_027_0	5	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5594	027	0	1	02	01	H5594_027_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	027	0	1	02	01	H5594_027_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	027	0	1	02	01	H5594_027_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	0.83	25.00		75.00																					0.83	25.00		50.00																		25.00				0.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	028	0	1	02	01	H5594_028_0	6	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	028	0	1	02	01	H5594_028_0	6	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	0.83	25.00		75.00																					0.83	25.00		50.00																		25.00				0.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	028	0	1	02	01	H5594_028_0	6	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.00	60.00		180.00																					2.00	60.00		120.00																		60.00				1.93	60.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	028	0	1	02	01	H5594_028_0	6	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	028	0	1	02	01	H5594_028_0	6	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5594	029	0	1	02	01	H5594_029_0	7	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	029	0	1	02	01	H5594_029_0	7	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.30	69.00		207.00																					2.30	69.00		138.00																		69.00				2.22	69.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	029	0	1	02	01	H5594_029_0	7	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	0.83	25.00		75.00																					0.83	25.00		50.00																		25.00				0.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	029	0	1	02	01	H5594_029_0	7	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	029	0	1	02	01	H5594_029_0	7	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5594	030	0	1	02	01	H5594_030_0	7	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5594	030	0	1	02	01	H5594_030_0	7	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	030	0	1	02	01	H5594_030_0	7	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		60.00																		30.00				0.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	030	0	1	02	01	H5594_030_0	7	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.50	75.00		225.00																					2.50	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	030	0	1	02	01	H5594_030_0	7	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	031	0	1	02	01	H5594_031_0	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		60.00																		30.00				0.96	30.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	031	0	1	02	01	H5594_031_0	8	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	031	0	1	02	01	H5594_031_0	8	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.50	75.00		225.00																					2.50	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	031	0	1	02	01	H5594_031_0	8	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	031	0	1	02	01	H5594_031_0	8	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5594	032	0	1	02	01	H5594_032_0	4	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	0.83	25.00		75.00																					0.83	25.00		50.00																		25.00				0.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	032	0	1	02	01	H5594_032_0	4	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	032	0	1	02	01	H5594_032_0	4	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.00	60.00		180.00																					2.00	60.00		120.00																		60.00				1.93	60.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	032	0	1	02	01	H5594_032_0	4	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5594	032	0	1	02	01	H5594_032_0	4	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	033	0	1	02	01	H5594_033_0	4	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	033	0	1	02	01	H5594_033_0	4	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	0.83	25.00		75.00																					0.83	25.00		50.00																		25.00				0.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	033	0	1	02	01	H5594_033_0	4	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	033	0	1	02	01	H5594_033_0	4	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.66	80.00		240.00																					2.66	80.00		160.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	033	0	1	02	01	H5594_033_0	4	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5608	002	0	1	01	01	H5608_002_0	6	4	Non-Preferred Brand	1	2	100000	1	1	111		10	100		1	31	60	90				1			90					10	31					74.04	45	45	45																							45																		45			45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5608	002	0	1	01	01	H5608_002_0	6	3	Preferred Brand	1	2	000001	1	1	111		10	100		1	31	60	90				1			90					10	31					44.57	25	25	25																							25																		25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5608	002	0	1	01	01	H5608_002_0	6	2	Non-Preferred Generic	1	2	000100	1	2	111		10	100		1	31	60	90				1			90					10	31	.19	6.00	12.00	12.00																								18.00																			6.00			.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5608	002	0	1	01	01	H5608_002_0	6	1	Preferred Generic	1	2	001000	1	2	111		10	100		1	31	60	90				1			90					10	31	.10	3.00	6.00	6.00																								9.00																			3.00			.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5609	001	0	1	01	01	H5609_001_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.14	5.00		15.00																								15.00																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5609	001	0	1	01	01	H5609_001_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.32	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	4	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					200.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.64	90.00		270.00																								270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.14	5.00		15.00																								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.44	15.00		45.00																								45.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.14	5.00		15.00																								15.00																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5609	004	0	1	01	01	H5609_004_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					200.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.64	90.00		270.00																								270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.32	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.14	5.00		15.00																								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.44	15.00		45.00																								45.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	005	0	1	01	01	H5609_005_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.44	15.00		45.00																								45.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	005	0	1	01	01	H5609_005_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.32	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	005	0	1	01	01	H5609_005_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.14	5.00		15.00																								15.00																		5.00				.14	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5609	005	0	1	01	01	H5609_005_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					200.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	005	0	1	01	01	H5609_005_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.64	90.00		270.00																								270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	005	0	1	01	01	H5609_005_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	.14	5.00		15.00																								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	001	0	1	01	01	H5619_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	001	0	1	01	01	H5619_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	001	0	1	01	01	H5619_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5619	001	0	1	01	01	H5619_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	001	0	1	01	01	H5619_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.36	11.00		33.00																												0.36	11.00		0.00				0.36	11.00		33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	007	0	1	01	01	H5619_007_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	007	0	1	01	01	H5619_007_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	007	0	1	01	01	H5619_007_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	007	0	1	01	01	H5619_007_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	007	0	1	01	01	H5619_007_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	007	0	1	01	01	H5619_007_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	007	0	1	01	01	H5619_007_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5619	007	0	1	01	01	H5619_007_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	007	0	1	01	01	H5619_007_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	007	0	1	01	01	H5619_007_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	009	0	1	01	01	H5619_009_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	009	0	1	01	01	H5619_009_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.36	11.00		33.00																												0.36	11.00		0.00				0.36	11.00		33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	009	0	1	01	01	H5619_009_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	009	0	1	01	01	H5619_009_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	009	0	1	01	01	H5619_009_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	10	1	Generic	1	4	010000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31						25																							25																			25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	10	3	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	10	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	001	0	1	01	01	H5649_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	001	0	1	01	01	H5649_001_0	7	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	001	0	1	01	01	H5649_001_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	.83	25.00		75.00																								50.00																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	001	0	1	01	01	H5649_001_0	7	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	1.66	50.00		150.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	001	0	1	01	01	H5649_001_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					343.53	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	001	0	1	01	01	H5649_001_0	7	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5649	001	0	1	01	01	H5649_001_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	.16	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5649	002	0	1	01	01	H5649_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	002	0	1	01	01	H5649_002_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	002	0	1	01	01	H5649_002_0	6	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				1			90				30		31					74.14	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	002	0	1	01	01	H5649_002_0	6	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5649	002	0	1	01	01	H5649_002_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					561.02	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	002	0	1	01	01	H5649_002_0	6	4	Non-Preferred Brand	1	4	100000	3	1	110		01	100		1	30		90				1			90				30		31					135.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	004	0	1	01	01	H5649_004_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	004	0	1	01	01	H5649_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	004	0	1	01	01	H5649_004_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					457.37	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	004	0	1	01	01	H5649_004_0	6	4	Non-Preferred Brand	1	4	100000	3	1	110		01	100		1	30		90				1			90				30		31					135.01	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	004	0	1	01	01	H5649_004_0	6	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				1			90				30		31					74.09	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	004	0	1	01	01	H5649_004_0	6	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5652	001	0	1	02	01	H5652_001_0	5	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					283.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	5	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	2.83	85.00		255.00																															245.00							255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.33	10.00		30.00																															20.00							30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	5	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					340.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	2.66	80.00		240.00																															230.00							240.00				80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.33	40.00		120.00																															110.00							120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	2.83	85.00		255.00																															245.00							255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.33	10.00		30.00																															20.00							30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					469.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31					283.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01		100	1	30		90				1						90	30		31	2.83	85.00		255.00																															245.00							255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.33	10.00		30.00																															20.00							30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.16	5.00		15.00																															10.00							15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	8	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	8	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	8	1	Preferred Generic	3	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5656	001	0	1	01	01	H5656_001_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5656	001	0	1	01	01	H5656_001_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5656	017	0	1	02	01	H5656_017_0	9	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5656	017	0	1	02	01	H5656_017_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5656	017	0	1	02	01	H5656_017_0	9	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5656	017	0	1	02	01	H5656_017_0	9	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5656	017	0	1	02	01	H5656_017_0	9	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5685	001	0	1	01	01	H5685_001_0	6	2	Brand	1	4	000010	1	2	010		10			1	30														29	31	0.00	0.00																																													0.00			0.00	0.00		Generic, Brand												
H5685	001	0	1	01	01	H5685_001_0	6	1	Generic	1	4	010000	1	2	010		10			1	30														29	31	0.00	0.00																																													0.00			0.00	0.00		Generic, Brand												
H5696	002	0	1	01	01	H5696_002_0	3	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	002	0	1	01	01	H5696_002_0	3	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	.83	25.00		75.00																								50.00																		25.00				.80	25.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	002	0	1	01	01	H5696_002_0	3	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	002	0	1	01	01	H5696_002_0	3	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					443.56	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	004	0	1	01	01	H5696_004_0	4	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	004	0	1	01	01	H5696_004_0	4	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.16	35.00		85.00																								70.00																		35.00				.80	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	004	0	1	01	01	H5696_004_0	4	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	004	0	1	01	01	H5696_004_0	4	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					522.48	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	021	0	1	01	01	H5696_021_0	6	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	021	0	1	01	01	H5696_021_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	021	0	1	01	01	H5696_021_0	6	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	021	0	1	01	01	H5696_021_0	6	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					380.82	25																							25																			25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	024	0	1	01	01	H5696_024_0	4	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	024	0	1	01	01	H5696_024_0	4	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.16	35.00		105.00																								70.00																		35.00				1.12	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	024	0	1	01	01	H5696_024_0	4	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	024	0	1	01	01	H5696_024_0	4	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					542.59	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	028	0	1	01	01	H5696_028_0	5	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	028	0	1	01	01	H5696_028_0	5	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.67	20.00		40.00																								30.00																		20.00				0.64	20.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	028	0	1	01	01	H5696_028_0	5	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					354.11	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	028	0	1	01	01	H5696_028_0	5	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	3.00	90.00		270.00																								270.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	030	0	1	01	01	H5696_030_0	4	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	030	0	1	01	01	H5696_030_0	4	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	030	0	1	01	01	H5696_030_0	4	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.83	25.00		75.00																								50.00																		25.00				0.80	25.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	030	0	1	01	01	H5696_030_0	4	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					580.50	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	033	0	1	01	01	H5696_033_0	4	1	Generic	3	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5696	033	0	1	01	01	H5696_033_0	4	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	033	0	1	01	01	H5696_033_0	4	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.83	25.00		75.00																								50.00																		25.00				0.80	25.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	033	0	1	01	01	H5696_033_0	4	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	2.83	85.00		255.00																								255.00																		85.00				2.74	85.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	033	0	1	01	01	H5696_033_0	4	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					464.80	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	034	0	1	01	01	H5696_034_0	4	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					503.13	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	034	0	1	01	01	H5696_034_0	4	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	.10	3.00		9.00																								6.00																		3.00				.09	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	034	0	1	01	01	H5696_034_0	4	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.16	35.00		105.00																								70.00																		35.00				1.12	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	034	0	1	01	01	H5696_034_0	4	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	035	0	1	01	01	H5696_035_0	4	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					536.82	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	035	0	1	01	01	H5696_035_0	4	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	3.17	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	035	0	1	01	01	H5696_035_0	4	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.67	20.00		60.00																								60.00																		20.00				0.64	20.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	035	0	1	01	01	H5696_035_0	4	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	035	0	1	01	01	H5696_035_0	4	1	Generic	3	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5696	037	0	1	01	01	H5696_037_0	5	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	037	0	1	01	01	H5696_037_0	5	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.50	15.00		45.00																								30.00																		15.00				0.48	15.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	037	0	1	01	01	H5696_037_0	5	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		240.00																								240.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	037	0	1	01	01	H5696_037_0	5	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					531.64	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	037	0	1	01	01	H5696_037_0	5	1	Generic	3	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5696	038	0	1	01	01	H5696_038_0	5	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	038	0	1	01	01	H5696_038_0	5	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.83	25.00		75.00																								50.00																		25.00				0.80	25.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	038	0	1	01	01	H5696_038_0	5	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	038	0	1	01	01	H5696_038_0	5	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					516.87	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	039	0	1	01	01	H5696_039_0	4	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		240.00																								240.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	039	0	1	01	01	H5696_039_0	4	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.50	15.00		45.00																								30.00																		15.00				0.48	15.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	039	0	1	01	01	H5696_039_0	4	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	039	0	1	01	01	H5696_039_0	4	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					532.57	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	039	0	1	01	01	H5696_039_0	4	1	Generic	3	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5696	040	0	1	01	01	H5696_040_0	4	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					505.07	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	040	0	1	01	01	H5696_040_0	4	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	040	0	1	01	01	H5696_040_0	4	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.16	35.00		105.00																								70.00																		35.00				1.12	35.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	040	0	1	01	01	H5696_040_0	4	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	.10	3.00		9.00																								6.00																		3.00				.09	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	041	0	1	01	01	H5696_041_0	4	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					531.55	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	041	0	1	01	01	H5696_041_0	4	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								115.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	041	0	1	01	01	H5696_041_0	4	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		20.00																								15.00																		10.00				0.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	041	0	1	01	01	H5696_041_0	4	1	Generic	3	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5696	041	0	1	01	01	H5696_041_0	4	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	043	0	1	01	01	H5696_043_0	4	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	043	0	1	01	01	H5696_043_0	4	1	Generic	3	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5696	043	0	1	01	01	H5696_043_0	4	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					597.37	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	043	0	1	01	01	H5696_043_0	4	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	2.66	80.00		240.00																								240.00																		80.00				2.58	80.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	043	0	1	01	01	H5696_043_0	4	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.50	15.00		45.00																								30.00																		15.00				0.48	15.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	046	0	1	01	01	H5696_046_0	6	1	Generic	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	046	0	1	01	01	H5696_046_0	6	1	Generic	3	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5696	046	0	1	01	01	H5696_046_0	6	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					505.07	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	046	0	1	01	01	H5696_046_0	6	3	Non-Preferred Brand	1	4	110000	3	2	110		01	100		1	30		90				1			90				30		31	.67	20.00		50.00																								40.00																		20.00				0.64	20.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	046	0	1	01	01	H5696_046_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5696	046	0	1	01	01	H5696_046_0	6	2	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5698	028	0	1	01	01	H5698_028_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	028	0	1	01	01	H5698_028_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.40	12.00	24.00	36.00																					.40	12.00	24.00	36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	028	0	1	01	01	H5698_028_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5698	028	0	1	01	01	H5698_028_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	028	0	1	01	01	H5698_028_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					573.71	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	028	0	1	01	01	H5698_028_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.43	43.00	86.00	129.00																					1.43	43.00	86.00	129.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	062	0	1	01	01	H5698_062_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	062	0	1	01	01	H5698_062_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	062	0	1	01	01	H5698_062_0	7	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					499.00	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	062	0	1	01	01	H5698_062_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5698	062	0	1	01	01	H5698_062_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	062	0	1	01	01	H5698_062_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.40	12.00	24.00	36.00																					.40	12.00	24.00	36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.40	12.00	24.00	36.00																					.40	12.00	24.00	36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					556.28	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5698	159	0	1	01	01	H5698_159_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	159	0	1	01	01	H5698_159_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.40	12.00	24.00	36.00																					.40	12.00	24.00	36.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	159	0	1	01	01	H5698_159_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	159	0	1	01	01	H5698_159_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	159	0	1	01	01	H5698_159_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					630.07	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	159	0	1	01	01	H5698_159_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5732	001	0	1	01	01	H5732_001_0	15	1	Preferred Generic	1	4	001000	3	2		110	01	100		1				30		90	1			90				30		31									.17	5.00		15.00					.23	7.00		21.00								10.00																		7.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5732	001	0	1	01	01	H5732_001_0	15	2	Non-Preferred Generic	1	4	000100	3	2		110	01	100		1				30		90	1			90				30		31									.50	15.00		45.00					.67	20.00		60.00								30.00																		20.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5732	001	0	1	01	01	H5732_001_0	15	3	Preferred Brand	1	4	000001	3	2		110	01	100		1				30		90	1			90				30		31									1.17	35.00		105.00					1.33	40.00		120.00								70.00																		40.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5732	001	0	1	01	01	H5732_001_0	15	4	Non-Preferred Brand	1	4	100000	3	3		110	01	100		1				30		90	1			90				30		31									1.33	40.00		120.00	1.00	25		25	1.50	45.00		135.00	1.00	25		25				80.00			25															45.00		25		1.29	40.00	25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5732	001	0	1	01	01	H5732_001_0	15	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	33		33							25																	33				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5732	001	0	1	01	01	H5732_001_0	15	1	Preferred Generic	3	4	001000	3	2		110	01	100		1				30		90	1			90				30		31									.16	5.00		15.00					.23	7.00		21.00								10.00																		7.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5732	001	0	1	01	01	H5732_001_0	15	2	Non-Preferred Generic	3	4	000100	3	2		110	01	100		1				30		90	1			90				30		31									.50	15.00		45.00					.67	20.00		60.00								30.00																		20.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5746	006	0	1	01	01	H5746_006_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5746	006	0	1	01	01	H5746_006_0	6	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5746	006	0	1	01	01	H5746_006_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5746	006	0	1	01	01	H5746_006_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5746	006	0	1	01	01	H5746_006_0	6	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5746	006	0	1	01	01	H5746_006_0	6	3	Preferred Brand	1	4	000001	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.57	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5746	006	0	1	01	01	H5746_006_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5746	012	0	1	01	01	H5746_012_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.06	2.00	4.00	6.00																					.06	2.00	3.00	4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5746	012	0	1	01	01	H5746_012_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.26	8.00	16.00	24.00																					.26	8.00	12.00	16.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5746	012	0	1	01	01	H5746_012_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	60.00	80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5746	012	0	1	01	01	H5746_012_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	2.58	80.00	160.00	240.00																					2.58	80.00	120.00	160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5746	012	0	1	01	01	H5746_012_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31						33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5746	012	0	1	01	01	H5746_012_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.06	2.00	4.00	6.00																					.06	2.00	3.00	4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5749	001	0	1	02	01	H5749_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					594.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5749	001	0	1	02	01	H5749_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5749	001	0	1	02	01	H5749_001_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5749	001	0	1	02	01	H5749_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5749	001	0	1	02	01	H5749_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5765	001	0	1	01	01	H5765_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	0.33	10.00		30.00																								25.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5765	001	0	1	01	01	H5765_001_0	7	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	1.33	40.00		120.00																								100.00																			40.00			1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5765	001	0	1	01	01	H5765_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	2.17	65.00		195.00																								162.50																			65.00			2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5765	001	0	1	01	01	H5765_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		10			1	30														29	31						25																																											25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5765	001	0	1	01	01	H5765_001_0	7	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	0.00	0.00		0.00																								0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	13	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									1.66	50.00		150.00					2.00	60.00		180.00								100.00																		60.00				.06	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	13	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		105.00					1.50	45.00		135.00								70.00																		45.00				.07	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	13	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.27	8.00		24.00					.67	20.00		60.00								16.00																		20.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	13	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31													1.00	33		33					1.00	33		33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	13	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.10	3.00		9.00					.23	7.00		21.00								6.00																		7.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	005	0	1	01	01	H5774_005_0	13	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.27	8.00		24.00					.67	20.00		60.00								16.00																		20.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	005	0	1	01	01	H5774_005_0	13	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.10	3.00		9.00					.23	7.00		21.00								6.00																		7.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	008	0	1	01	01	H5774_008_0	16	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31														33		33						33		33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	008	0	1	01	01	H5774_008_0	16	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.20	6.00		18.00					.30	9.00		27.00								12.00																		9.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	008	0	1	01	01	H5774_008_0	16	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.50	15.00		45.00					.83	25.00		75.00								30.00																		25.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	008	0	1	01	01	H5774_008_0	16	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									1.66	50.00		150.00					2.33	70.00		210.00								100.00																		70.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	008	0	1	01	01	H5774_008_0	16	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.20	6.00		18.00					.30	9.00		27.00								12.00																		9.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	008	0	1	01	01	H5774_008_0	16	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.50	15.00		45.00					.83	25.00		75.00								30.00																		25.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	008	0	1	01	01	H5774_008_0	16	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.33	40.00		120.00					1.50	45.00		135.00								80.00																		45.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	009	0	1	01	01	H5774_009_0	16	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.26	8.00		24.00					.67	20.00		60.00								16.00																		20.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	009	0	1	01	01	H5774_009_0	16	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.17	35.00		105.00					1.50	45.00		135.00								70.00																		45.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	009	0	1	01	01	H5774_009_0	16	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31									1.67	50.00		150.00					2.00	60.00		180.00								100.00																		60.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	009	0	1	01	01	H5774_009_0	16	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.27	8.00		24.00					.67	20.00		60.00								16.00																		20.00				.27	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	009	0	1	01	01	H5774_009_0	16	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.10	3.00		9.00					.23	7.00		21.00								6.00																		7.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	009	0	1	01	01	H5774_009_0	16	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31														33		33						33		33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	009	0	1	01	01	H5774_009_0	16	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.10	3.00		9.00					.23	7.00		21.00								6.00																		7.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	014	0	1	02	01	H5774_014_0	17	1	Preferred Generic	3	4	001000	3	2		110	01	100		1				30		90	2			90				30		31									.17	5.00		15.00					.27	8.00		24.00								10.00																		8.00				.17	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	014	0	1	02	01	H5774_014_0	17	2	Non-Preferred Generic	3	4	000100	3	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.83	25.00		75.00								20.00																		25.00				.33	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	014	0	1	02	01	H5774_014_0	17	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31														33		33						33		33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	014	0	1	02	01	H5774_014_0	17	4	Non-Preferred Brand	1	4	100000	3	2		110	01	100		1				30		90	1			90				30		31									2.33	70.00		210.00					2.50	75.00		225.00								140.00																		75.00				2.26	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	014	0	1	02	01	H5774_014_0	17	3	Preferred Brand	1	4	000001	3	2		110	01	100		1				30		90	1			90				30		31									1.17	35.00		105.00					1.50	45.00		135.00								70.00																		45.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	014	0	1	02	01	H5774_014_0	17	2	Non-Preferred Generic	1	4	000100	3	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.83	25.00		75.00								20.00																		25.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	014	0	1	02	01	H5774_014_0	17	1	Preferred Generic	1	4	001000	3	2		110	01	100		1				30		90	2			90				30		31									.17	5.00		15.00					.27	8.00		24.00								10.00																		8.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	7	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	31		90				2			90				31		31						25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.45	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	.16	5.00		15.00																								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.74	85.00		255.00																								255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5782	001	0	1	01	01	H5782_001_0	7	1	Generic	1	4	010000	1	2	110		10	110		1	30		90				1	30		90					29	31	0.00	0.00		0.00																					0.00	0.00		0.00																			0.00			0.00	0.00		Generic, Brand												
H5782	001	0	1	01	01	H5782_001_0	7	2	Brand	1	4	000010	1	2	110		10	110		1	30		90				1	30		90					29	31	1.48	45.00		135.00																					1.48	45.00		135.00																			45.00			1.45	45.00		Generic, Brand												
H5786	002	0	1	01	01	H5786_002_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5786	002	0	1	01	01	H5786_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	.16	5.00		15.00																								15.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5786	002	0	1	01	01	H5786_002_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.45	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5786	002	0	1	01	01	H5786_002_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.74	85.00		255.00																								255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5786	002	0	1	01	01	H5786_002_0	7	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	31		90				2			90				31		31						25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5793	001	0	1	01	01	H5793_001_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5793	001	0	1	01	01	H5793_001_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5793	001	0	1	01	01	H5793_001_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5793	001	0	1	01	01	H5793_001_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5793	001	0	1	01	01	H5793_001_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5793	008	0	1	01	01	H5793_008_0	6	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5793	008	0	1	01	01	H5793_008_0	6	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5793	008	0	1	01	01	H5793_008_0	6	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5793	008	0	1	01	01	H5793_008_0	6	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5793	008	0	1	01	01	H5793_008_0	6	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5793	008	0	1	01	01	H5793_008_0	6	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5810	001	0	1	01	01	H5810_001_0	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31						25																							25																			25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	10	3	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	10	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	10	1	Generic	1	4	010000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5811	001	0	1	01	01	H5811_001_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5811	001	0	1	01	01	H5811_001_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5811	001	0	1	01	01	H5811_001_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5811	001	0	1	01	01	H5811_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					681.92	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5811	001	0	1	01	01	H5811_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.41	75.00	150.00	225.00																					2.41	75.00	150.00	150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5811	001	0	1	01	01	H5811_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	80.00	80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5811	001	0	1	01	01	H5811_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5811	001	0	1	01	01	H5811_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5811	005	0	1	01	01	H5811_005_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5811	005	0	1	01	01	H5811_005_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5811	005	0	1	01	01	H5811_005_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5811	005	0	1	01	01	H5811_005_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					1207.69	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5811	005	0	1	01	01	H5811_005_0	4	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5811	005	0	1	01	01	H5811_005_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.58	80.00	160.00	240.00																					2.58	80.00	160.00	160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5813	003	0	1	01	01	H5813_003_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.26	8.00	16.00	24.00																												.26	8.00	16.00	16.00				.26	8.00	16.00	24.00					8.00			.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5813	003	0	1	01	01	H5813_003_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5813	003	0	1	01	01	H5813_003_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5813	003	0	1	01	01	H5813_003_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.26	8.00	16.00	24.00					8.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5813	003	0	1	01	01	H5813_003_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.26	8.00	16.00	24.00					8.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5813	003	0	1	01	01	H5813_003_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5813	006	0	1	01	01	H5813_006_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.26	8.00	16.00	24.00					8.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5813	006	0	1	01	01	H5813_006_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.26	8.00	16.00	24.00					8.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5813	006	0	1	01	01	H5813_006_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5813	006	0	1	01	01	H5813_006_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5813	006	0	1	01	01	H5813_006_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5813	006	0	1	01	01	H5813_006_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.26	8.00	16.00	24.00																												.26	8.00	16.00	16.00				.26	8.00	16.00	24.00					8.00			.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	009	0	1	01	01	H5817_009_0	13	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5817	009	0	1	01	01	H5817_009_0	13	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5817	009	0	1	01	01	H5817_009_0	13	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5817	009	0	1	01	01	H5817_009_0	13	3	Preferred Brand	1	4	000001	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.57	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5817	009	0	1	01	01	H5817_009_0	13	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5817	009	0	1	01	01	H5817_009_0	13	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5817	009	0	1	01	01	H5817_009_0	13	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5817	010	0	1	01	01	H5817_010_0	13	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5817	010	0	1	01	01	H5817_010_0	13	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.13	4.00	8.00	12.00																					.13	4.00	6.00	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5817	010	0	1	01	01	H5817_010_0	13	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.29	40.00	80.00	120.00																					1.29	40.00	60.00	80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5817	010	0	1	01	01	H5817_010_0	13	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31						33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5817	010	0	1	01	01	H5817_010_0	13	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	2.58	80.00	160.00	240.00																					2.58	80.00	120.00	160.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	34		90				1			90				34		34	0.29	10.00		30.00																								30.00																		10.00				0.29	10.00		Preferred Generic, Preferred Brand, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	34		90				1			90				34		34	1.47	50.00		150.00																								150.00																		50.00				1.47	50.00		Preferred Generic, Preferred Brand, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	7	3	Specialty Tier	1	4	010010	1	1	110		01	100		1	34		90				1			90				34		34					9.08	33		33																							33																	33				33	Preferred Generic, Preferred Brand, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	34		90				1			90				34		34	0.29	10.00		30.00																								30.00																		10.00				.29	10.00		Preferred Generic, Preferred Brand, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	34		90				1			90				34		34	1.47	50.00		150.00																								150.00																		50.00				1.47	50.00		Preferred Generic, Preferred Brand, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	7	3	Specialty Tier	1	4	010010	1	1	110		01	100		1	34		90				1			90				34		34					4.20	33		33																							33																	33				33	Preferred Generic, Preferred Brand, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	34		90				1			90				34		34	0.29	10.00		30.00																								30.00																		10.00				0.29	10.00		Preferred Generic, Preferred Brand, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	34		90				1			90				34		34	1.47	50.00		150.00																								150.00																		50.00				1.47	50.00		Preferred Generic, Preferred Brand, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	7	3	Specialty Tier	1	4	010000	1	1	110		01	100		1	34		90				1			90				34		34					5.26	33		33																							33																	33				33	Preferred Generic, Preferred Brand, Specialty Tier												
H5832	001	0	1	01	01	H5832_001_0	7	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5832	001	0	1	01	01	H5832_001_0	7	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.43	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5832	001	0	1	01	01	H5832_001_0	7	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5832	001	0	1	01	01	H5832_001_0	7	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5832	001	0	1	01	01	H5832_001_0	7	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5832	001	0	1	01	01	H5832_001_0	7	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					78.03	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5850	002	0	1	01	01	H5850_002_0	14	4	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	002	0	1	01	01	H5850_002_0	14	3	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	002	0	1	01	01	H5850_002_0	14	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.50	45.00	90.00	90.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	002	0	1	01	01	H5850_002_0	14	1	Preferred Generic	1	4	001010	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	002	0	1	01	01	H5850_002_0	14	1	Preferred Generic	3	4	001010	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5850	003	0	1	01	01	H5850_003_0	8	2	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.50	15.00	30.00	30.00					.83	25.00	50.00	50.00					.50	15.00	30.00	30.00																		25.00				.80	25.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	003	0	1	01	01	H5850_003_0	8	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.50	45.00	90.00	135.00					2.00	60.00	120.00	180.00					1.50	45.00	90.00	135.00																		60.00				1.93	60.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	003	0	1	01	01	H5850_003_0	8	4	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	003	0	1	01	01	H5850_003_0	8	1	Preferred Generic	3	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.16	5.00	10.00	10.00					.26	8.00	16.00	16.00					.16	5.00	10.00	10.00																		8.00				.25	8.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5850	003	0	1	01	01	H5850_003_0	8	1	Preferred Generic	1	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					.10	3.00	6.00	6.00					0.00	0.00	0.00	0.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	004	0	1	01	01	H5850_004_0	8	4	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	004	0	1	01	01	H5850_004_0	8	1	Preferred Generic	3	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.16	5.00	10.00	10.00					.26	8.00	16.00	16.00					.16	5.00	10.00	10.00																		8.00				.25	8.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5850	004	0	1	01	01	H5850_004_0	8	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.33	70.00	140.00	210.00					2.83	85.00	170.00	255.00					2.33	70.00	140.00	210.00																		85.00				2.74	85.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	004	0	1	01	01	H5850_004_0	8	2	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.00	30.00	60.00	60.00					1.33	40.00	80.00	80.00					1.00	30.00	60.00	60.00																		40.00				1.29	40.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	004	0	1	01	01	H5850_004_0	8	1	Preferred Generic	1	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					.10	3.00	6.00	6.00					0.00	0.00	0.00	0.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	006	0	1	01	01	H5850_006_0	8	1	Preferred Generic	3	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.16	5.00	10.00	10.00					.26	8.00	16.00	16.00					.16	5.00	10.00	10.00																		8.00				.25	8.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5850	006	0	1	01	01	H5850_006_0	8	4	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	006	0	1	01	01	H5850_006_0	8	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.00	60.00	120.00	180.00					2.50	75.00	150.00	225.00					2.00	60.00	120.00	180.00																		75.00				2.41	75.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	006	0	1	01	01	H5850_006_0	8	2	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.33	10.00	20.00	20.00					.66	20.00	40.00	40.00					.33	10.00	20.00	20.00																		20.00				.64	20.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	006	0	1	01	01	H5850_006_0	8	1	Preferred Generic	1	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	007	0	1	01	01	H5850_007_0	8	4	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	007	0	1	01	01	H5850_007_0	8	1	Preferred Generic	3	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.16	5.00	10.00	10.00					.26	8.00	16.00	16.00					.16	5.00	10.00	10.00																		8.00				.25	8.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5850	007	0	1	01	01	H5850_007_0	8	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.16	65.00	130.00	195.00					2.66	80.00	160.00	240.00					2.16	65.00	130.00	195.00																		80.00				2.58	80.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	007	0	1	01	01	H5850_007_0	8	2	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.00	30.00	60.00	60.00					1.33	40.00	80.00	80.00					1.00	30.00	60.00	60.00																		40.00				1.29	40.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	007	0	1	01	01	H5850_007_0	8	1	Preferred Generic	1	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					.10	3.00	6.00	6.00					0.00	0.00	0.00	0.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	012	0	1	01	01	H5850_012_0	9	1	Preferred Generic	1	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					.10	3.00	6.00	6.00					0.00	0.00	0.00	0.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	012	0	1	01	01	H5850_012_0	9	1	Preferred Generic	3	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					.10	3.00	6.00	6.00					0.00	0.00	0.00	0.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5850	012	0	1	01	01	H5850_012_0	9	4	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	012	0	1	01	01	H5850_012_0	9	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.66	50.00	100.00	150.00					1.16	35.00	70.00	105.00																		50.00				1.61	50.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	012	0	1	01	01	H5850_012_0	9	2	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.16	5.00	10.00	10.00					.50	15.00	30.00	30.00					.16	5.00	10.00	10.00																		15.00				.48	15.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	022	0	1	01	01	H5850_022_0	8	4	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	022	0	1	01	01	H5850_022_0	8	2	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	70.00					1.50	45.00	90.00	90.00					1.16	35.00	70.00	70.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	022	0	1	01	01	H5850_022_0	8	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.50	75.00	150.00	225.00					3.00	90.00	180.00	270.00					2.50	75.00	150.00	225.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	022	0	1	01	01	H5850_022_0	8	1	Preferred Generic	1	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	023	0	1	01	01	H5850_023_0	7	1	Preferred Generic	1	4	001010	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	023	0	1	01	01	H5850_023_0	7	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.50	45.00	90.00	90.00																					1.50	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	023	0	1	01	01	H5850_023_0	7	3	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	023	0	1	01	01	H5850_023_0	7	4	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	025	0	1	01	01	H5850_025_0	7	1	Preferred Generic	1	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					.10	3.00	6.00	6.00					0.00	0.00	0.00	0.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	025	0	1	01	01	H5850_025_0	7	2	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.83	25.00	50.00	50.00					1.16	35.00	70.00	70.00					.83	25.00	50.00	50.00																		35.00				1.12	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	025	0	1	01	01	H5850_025_0	7	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.00	60.00	120.00	180.00					2.50	75.00	150.00	225.00					2.00	60.00	120.00	180.00																		75.00				2.41	75.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	025	0	1	01	01	H5850_025_0	7	4	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	025	0	1	01	01	H5850_025_0	7	1	Preferred Generic	3	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.16	5.00	10.00	10.00					.26	8.00	16.00	16.00					.16	5.00	10.00	10.00																		8.00				.25	8.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5850	027	0	1	01	01	H5850_027_0	7	4	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	027	0	1	01	01	H5850_027_0	7	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.50	75.00	150.00	225.00					3.00	90.00	180.00	270.00					2.50	75.00	150.00	225.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	027	0	1	01	01	H5850_027_0	7	2	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	70.00					1.50	45.00	90.00	90.00					1.16	35.00	70.00	70.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5850	027	0	1	01	01	H5850_027_0	7	1	Preferred Generic	1	4	001010	3	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					.16	5.00	10.00	10.00					0.00	0.00	0.00	0.00																		5.00				.16	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5852	001	0	1	01	01	H5852_001_0	4	3	Non-Preferred Brand	1	2	100000	1	1	010		01			1	30													30		34					2000.00	25																																										25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5852	001	0	1	01	01	H5852_001_0	4	1	Preferred Generic	1	2	001001	1	1	110		01			1	30		90				1							30		34					2000.00	25		25																																								25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5852	001	0	1	01	01	H5852_001_0	4	2	Preferred Brand	1	2	010001	1	1	110		01			1	30		90				1							30		34					2000.00	25		25																																								25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5854	005	0	1	01	01	H5854_005_0	6	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5854	005	0	1	01	01	H5854_005_0	6	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5854	005	0	1	01	01	H5854_005_0	6	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													59.00	33	33	33					59.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5854	005	0	1	01	01	H5854_005_0	6	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5854	005	0	1	01	01	H5854_005_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.59	20.00	40.00	60.00					.74	25.00	50.00	75.00					.59	20.00	40.00	40.00																		25.00				.74	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5854	005	0	1	01	01	H5854_005_0	6	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5859	001	0	1	02	01	H5859_001_0	12	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	31	60	90				2	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5859	001	0	1	02	01	H5859_001_0	12	2	Preferred Brand	1	4	000101	1	1	111		01	111		1	31	60	90				2	31	60	90				31		31					22.47	25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5859	001	0	1	02	01	H5859_001_0	12	3	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	31	60	90				2	31	60	90				31		31					20.24	25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5859	001	0	1	02	01	H5859_001_0	12	1	Preferred Generic	3	4	001001	1	2	111		01	111		1	31	60	90				2	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand										1		
H5859	003	0	1	02	01	H5859_003_0	11	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	31	60	90				2	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5859	003	0	1	02	01	H5859_003_0	11	3	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	31	60	90				2	31	60	90				31		31					20.61	25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5859	003	0	1	02	01	H5859_003_0	11	2	Preferred Brand	1	4	000101	1	2	111		01	111		1	31	60	90				2	31	60	90				31		31	.16	5.00	10.00	15.00																					0.00	5.00	10.00	15.00																		5.00				0.00	5.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
H5868	001	0	1	04	01	H5868_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	001	0	1	04	01	H5868_001_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	001	0	1	04	01	H5868_001_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5868	001	0	1	04	01	H5868_001_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5868	001	0	1	04	01	H5868_001_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5868	001	0	1	04	01	H5868_001_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5868	001	0	1	04	01	H5868_001_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5868	001	0	1	04	01	H5868_001_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	001	0	1	04	01	H5868_001_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	001	0	1	04	01	H5868_001_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	009	0	1	04	01	H5868_009_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	009	0	1	04	01	H5868_009_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	009	0	1	04	01	H5868_009_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5868	009	0	1	04	01	H5868_009_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5868	009	0	1	04	01	H5868_009_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5868	009	0	1	04	01	H5868_009_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5868	009	0	1	04	01	H5868_009_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	009	0	1	04	01	H5868_009_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	009	0	1	04	01	H5868_009_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	009	0	1	04	01	H5868_009_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5868	010	0	1	04	01	H5868_010_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	010	0	1	04	01	H5868_010_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.80	84.00		252.00																												2.80	84.00		242.00				2.80	84.00		252.00				84.00				2.70	84.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	010	0	1	04	01	H5868_010_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.40	42.00		126.00																												1.40	42.00		116.00				1.40	42.00		126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	010	0	1	04	01	H5868_010_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	010	0	1	04	01	H5868_010_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	010	0	1	04	01	H5868_010_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5868	010	0	1	04	01	H5868_010_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.40	42.00		126.00																												1.40	42.00		116.00				1.40	42.00		126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5868	010	0	1	04	01	H5868_010_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5868	010	0	1	04	01	H5868_010_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5868	010	0	1	04	01	H5868_010_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.80	84.00		252.00																												2.80	84.00		242.00				2.80	84.00		252.00				84.00				2.70	84.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5868	012	0	1	04	01	H5868_012_0	5	5	Specialty Tier	3	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	27							1.00	27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5868	012	0	1	04	01	H5868_012_0	5	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.00	90.00		270.00					3.16	95.00		285.00												3.00	90.00		260.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5868	012	0	1	04	01	H5868_012_0	5	3	Preferred Brand	3	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	15		15					35.00	25		25												15		15					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5868	012	0	1	04	01	H5868_012_0	5	2	Non-Preferred Generic	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.23	7.00		21.00												0.10	3.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5868	012	0	1	04	01	H5868_012_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	27							1.00	27														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	012	0	1	04	01	H5868_012_0	5	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.13	4.00		12.00												0.03	1.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	012	0	1	04	01	H5868_012_0	5	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.23	7.00		21.00												0.10	3.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	012	0	1	04	01	H5868_012_0	5	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													14.00	15		15					24.00	25		25												15		15					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	012	0	1	04	01	H5868_012_0	5	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													40.00	30		30					69.00	50		50												30		30					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	013	0	1	04	01	H5868_013_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	013	0	1	04	01	H5868_013_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	013	0	1	04	01	H5868_013_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	013	0	1	04	01	H5868_013_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5868	013	0	1	04	01	H5868_013_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	8	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		7.50					.09	3.00		9.00					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		25.00					.29	10.00		30.00					.29	10.00		25.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	8	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.18	40.00		100.00					1.18	40.00		120.00					1.18	40.00		100.00																		40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.35	80.00		200.00					2.35	80.00		240.00					2.35	80.00		200.00																		80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	8	1	Preferred Generic	3	4	001000	1	1		110	01	110		1				34		90	1	34		90				34		34													5.50	50		45					5.50	50		50					50		45																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	002	2	1	02	01	H5883_002_2	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		25.00					.29	10.00		30.00					.29	10.00		25.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	8	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		7.50					.09	3.00		9.00					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	8	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.18	40.00		100.00					1.18	40.00		120.00					1.18	40.00		100.00																		40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	8	1	Preferred Generic	3	4	001000	1	1		110	01	110		1				34		90	1	34		90				34		34													5.50	50		45					5.50	50		50					50		45																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	002	2	1	02	01	H5883_002_2	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.35	80.00		200.00					2.35	80.00		240.00					2.35	80.00		200.00																		80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	9	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		7.50					.09	3.00		9.00					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		25.00					.29	10.00		30.00					.29	10.00		25.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.35	80.00		200.00					2.35	80.00		240.00					2.35	80.00		200.00																		80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	9	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.18	40.00		100.00					1.18	40.00		120.00					1.18	40.00		100.00																		40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	9	1	Preferred Generic	3	4	001000	1	1		110	01	110		1				34		90	1	34		90				34		34													5.50	50		45					5.50	50		50					50		45																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	002	4	1	02	01	H5883_002_4	8	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		25.00					.29	10.00		30.00					.29	10.00		25.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	8	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		7.50					.09	3.00		9.00					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	8	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.18	40.00		100.00					1.18	40.00		120.00					1.18	40.00		100.00																		40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	8	1	Preferred Generic	3	4	001000	1	1		110	01	110		1				34		90	1	34		90				34		34													5.50	50		45					5.50	50		50					50		45																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	002	4	1	02	01	H5883_002_4	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.35	80.00		200.00					2.35	80.00		240.00					2.35	80.00		200.00																		80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		25.00					.29	10.00		30.00					.29	10.00		25.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		7.50					.09	3.00		9.00					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.18	40.00		100.00					1.18	40.00		120.00					1.18	40.00		100.00																		40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.35	80.00		200.00					2.35	80.00		240.00					2.35	80.00		200.00																		80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	7	1	Preferred Generic	3	4	001000	1	1		110	01	110		1				34		90	1	34		90				34		34													5.50	50		45					5.50	50		50					50		45																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	003	1	1	02	01	H5883_003_1	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		25.00					.29	10.00		30.00					.29	10.00		25.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		7.50					.09	3.00		9.00					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.03	35.00		87.50					1.03	35.00		105.00					1.03	35.00		87.50																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	7	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.15	5.00		12.50					.15	5.00		15.00					.15	5.00		12.50																		5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	003	1	1	02	01	H5883_003_1	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.21	75.00		187.50					2.21	75.00		225.00					2.21	75.00		187.50																		75.00				2.21	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		7.50					.09	3.00		9.00					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		25.00					.29	10.00		30.00					.29	10.00		25.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.03	35.00		87.50					1.03	35.00		105.00					1.03	35.00		87.50																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.21	75.00		187.50					2.21	75.00		225.00					2.21	75.00		187.50																		75.00				2.21	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	7	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.15	5.00		12.50					.15	5.00		15.00					.15	5.00		12.50																		5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	003	3	1	02	01	H5883_003_3	7	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.15	5.00		12.50					.15	5.00		15.00					.15	5.00		12.50																		5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	003	3	1	02	01	H5883_003_3	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		7.50					.09	3.00		9.00					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		25.00					.29	10.00		30.00					.29	10.00		25.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.03	35.00		87.50					1.03	35.00		105.00					1.03	35.00		87.50																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.21	75.00		187.50					2.21	75.00		225.00					2.21	75.00		187.50																		75.00				2.21	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.21	75.00		187.50					2.21	75.00		225.00					2.21	75.00		187.50																		75.00				2.21	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.03	35.00		87.50					1.03	35.00		105.00					1.03	35.00		87.50																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		25.00					.29	10.00		30.00					.29	10.00		25.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		7.50					.09	3.00		9.00					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	7	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.15	5.00		12.50					.15	5.00		15.00					.15	5.00		12.50																		5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	003	5	1	02	01	H5883_003_5	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.21	75.00		187.50					2.21	75.00		225.00					2.21	75.00		187.50																		75.00				2.21	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.03	35.00		87.50					1.03	35.00		105.00					1.03	35.00		87.50																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		25.00					.29	10.00		30.00					.29	10.00		25.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.09	3.00		7.50					.09	3.00		9.00					.09	3.00		7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	7	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.15	5.00		12.50					.15	5.00		15.00					.15	5.00		12.50																		5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	005	0	1	01	01	H5883_005_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													1.00	30							1.00	30							30																			30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	005	0	1	01	01	H5883_005_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.35	80.00		200.00					2.35	80.00		240.00					2.35	80.00		200.00																		80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	005	0	1	01	01	H5883_005_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.32	45.00		112.50					1.32	45.00		135.00					1.32	45.00		112.50																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	005	0	1	01	01	H5883_005_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.29	10.00		25.00					.29	10.00		30.00					.29	10.00		25.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	005	0	1	01	01	H5883_005_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.12	4.00		10.00					.12	4.00		12.00					.12	4.00		10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	006	0	1	01	01	H5883_006_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	006	0	1	01	01	H5883_006_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34									2.79	95.00		237.50					2.79	95.00		285.00					2.79	95.00		237.50																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	006	0	1	01	01	H5883_006_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34									1.32	45.00		112.50					1.32	45.00		135.00					1.32	45.00		112.50																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	006	0	1	01	01	H5883_006_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34									.44	15.00		37.50					.44	15.00		45.00					.44	15.00		37.50																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	006	0	1	01	01	H5883_006_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.21	7.00		17.50					.21	7.00		21.00					.21	7.00		17.50																		7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	006	0	1	01	01	H5883_006_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34									.15	5.00		12.50					.15	5.00		15.00					.15	5.00		12.50																		5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	001	0	1	01	01	H5887_001_0	12	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	.83	25.00		75.00																								50.00																		25.00				.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	001	0	1	01	01	H5887_001_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	1.66	50.00		150.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	001	0	1	01	01	H5887_001_0	12	5	Specialty Tier	1	4	010010	1	1	110		01			1	30		90				2							30		31						25		25																																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	001	0	1	01	01	H5887_001_0	12	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.17	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5887	001	0	1	01	01	H5887_001_0	12	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5887	001	0	1	01	01	H5887_001_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.17	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	001	0	1	01	01	H5887_001_0	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	007	0	1	01	01	H5887_007_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.20	6.00		18.00																								12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	007	0	1	01	01	H5887_007_0	12	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.40	12.00		36.00																								24.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5887	007	0	1	01	01	H5887_007_0	12	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.20	6.00		18.00																								12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5887	007	0	1	01	01	H5887_007_0	12	5	Specialty Tier	1	4	010010	1	1	110		01			1	30		90				2							30		31						25		25																																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	007	0	1	01	01	H5887_007_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	1.67	50.00		150.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	007	0	1	01	01	H5887_007_0	12	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		90.00																								60.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	007	0	1	01	01	H5887_007_0	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.40	12.00		36.00																								24.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	012	0	1	01	01	H5887_012_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.17	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	012	0	1	01	01	H5887_012_0	12	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	012	0	1	01	01	H5887_012_0	12	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.16	35.00		105.00																								70.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	012	0	1	01	01	H5887_012_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	1.83	55.00		165.00																								110.00																		55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	012	0	1	01	01	H5887_012_0	12	5	Specialty Tier	1	4	010010	1	1	110		01			1	30		90				2							30		31						25		25																																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	012	0	1	01	01	H5887_012_0	12	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.17	5.00		15.00																								10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5887	012	0	1	01	01	H5887_012_0	12	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.33	10.00		30.00																								20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5887	013	0	1	01	01	H5887_013_0	14	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.23	7.00		21.00																								14.00																		7.00				.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5887	013	0	1	01	01	H5887_013_0	14	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.50	15.00		45.00																								30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5887	013	0	1	01	01	H5887_013_0	14	5	Specialty Tier	1	4	010010	1	1	110		01			1	30		90				2							30		31						25		25																																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	013	0	1	01	01	H5887_013_0	14	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.17	65.00		195.00																								130.00																		65.00				2.10	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	013	0	1	01	01	H5887_013_0	14	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.33	40.00		120.00																								80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	013	0	1	01	01	H5887_013_0	14	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.50	15.00		45.00																								30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5887	013	0	1	01	01	H5887_013_0	14	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.23	7.00		21.00																								14.00																		7.00				.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5896	007	0	1	01	01	H5896_007_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5896	007	0	1	01	01	H5896_007_0	6	2	Non-Preferred Generic	1	4	000100	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					1.21	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5896	007	0	1	01	01	H5896_007_0	6	3	Preferred Brand	1	4	000001	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.57	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5896	007	0	1	01	01	H5896_007_0	6	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5896	007	0	1	01	01	H5896_007_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5896	007	0	1	01	01	H5896_007_0	6	1	Preferred Generic	3	4	001000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					0.00	0	0	0																					0	0	0																	0				0	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5926	001	0	1	01	01	H5926_001_0	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31						25																							25																			25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	9	3	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	9	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	9	1	Generic	1	4	010000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	001	0	1	01	01	H5928_001_0	5	4	Non-Preferred Brand	1	4	100100	1	1	110		01	100		1	30		90				2			90				30		31					41.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	001	0	1	01	01	H5928_001_0	5	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31					46.44	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	001	0	1	01	01	H5928_001_0	5	2	Non-Preferred Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31					4.87	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	001	0	1	01	01	H5928_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	001	0	1	01	01	H5928_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					509.98	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	001	0	1	01	01	H5928_001_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	004	0	1	01	01	H5928_004_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		60.00																								60.00																		30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	1.67	50.00		100.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					620.85	30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	004	0	1	01	01	H5928_004_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	005	0	1	01	01	H5928_005_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	8	2	Non-Preferred Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31					4.87	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	005	0	1	01	01	H5928_005_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					509.98	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	8	4	Non-Preferred Brand	1	4	100100	1	1	110		01	100		1	30		90				2			90				30		31					41.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	8	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31					46.44	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.23	7.00		14.00																								14.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.17	35.00		70.00																								70.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	2.00	60.00		120.00																								120.00																		60.00				1.94	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					620.85	30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	010	0	1	01	01	H5928_010_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.23	7.00		14.00																								14.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	012	0	1	01	01	H5928_012_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	012	0	1	01	01	H5928_012_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	012	0	1	01	01	H5928_012_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	012	0	1	01	01	H5928_012_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					620.85	30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	012	0	1	01	01	H5928_012_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	1.67	50.00		100.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	012	0	1	01	01	H5928_012_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		60.00																								60.00																		30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	012	0	1	01	01	H5928_012_0	7	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	016	0	1	01	01	H5928_016_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					620.85	30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	016	0	1	01	01	H5928_016_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	016	0	1	01	01	H5928_016_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		60.00																								60.00																		30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	1.67	50.00		100.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	020	0	1	01	01	H5928_020_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		60.00																								60.00																		30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	020	0	1	01	01	H5928_020_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	1.67	50.00		100.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	020	0	1	01	01	H5928_020_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					620.85	30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	020	0	1	01	01	H5928_020_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	020	0	1	01	01	H5928_020_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	020	0	1	01	01	H5928_020_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	020	0	1	01	01	H5928_020_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	022	0	1	01	01	H5928_022_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		60.00																								60.00																		30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	022	0	1	01	01	H5928_022_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	022	0	1	01	01	H5928_022_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	022	0	1	01	01	H5928_022_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	1.67	50.00		100.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	022	0	1	01	01	H5928_022_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	022	0	1	01	01	H5928_022_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	022	0	1	01	01	H5928_022_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					620.85	30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	024	0	1	01	01	H5928_024_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	024	0	1	01	01	H5928_024_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	024	0	1	01	01	H5928_024_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		60.00																								60.00																		30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	024	0	1	01	01	H5928_024_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	024	0	1	01	01	H5928_024_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					620.85	30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	024	0	1	01	01	H5928_024_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	1.67	50.00		100.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	024	0	1	01	01	H5928_024_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	025	0	1	01	01	H5928_025_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					509.98	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	025	0	1	01	01	H5928_025_0	5	4	Non-Preferred Brand	1	4	100100	1	1	110		01	100		1	30		90				2			90				30		31					41.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	025	0	1	01	01	H5928_025_0	5	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31					46.44	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	025	0	1	01	01	H5928_025_0	5	2	Non-Preferred Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31					4.87	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	025	0	1	01	01	H5928_025_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	025	0	1	01	01	H5928_025_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	036	0	1	01	01	H5928_036_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	036	0	1	01	01	H5928_036_0	5	2	Non-Preferred Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	036	0	1	01	01	H5928_036_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.83	25.00		75.00																								75.00																		25.00				0.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	036	0	1	01	01	H5928_036_0	5	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				2			90				30		31	1.33	40.00		120.00																								120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	036	0	1	01	01	H5928_036_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					601.85	30																							30																			30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	036	0	1	01	01	H5928_036_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	036	0	1	01	01	H5928_036_0	5	2	Non-Preferred Generic	3	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	037	0	1	01	01	H5928_037_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	5	2	Non-Preferred Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31					4.87	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	5	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31					46.44	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	5	4	Non-Preferred Brand	1	4	100100	1	1	110		01	100		1	30		90				2			90				30		31					41.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					509.98	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	038	0	1	01	01	H5928_038_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	038	0	1	01	01	H5928_038_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	038	0	1	01	01	H5928_038_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	038	0	1	01	01	H5928_038_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					620.85	30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	038	0	1	01	01	H5928_038_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	1.67	50.00		100.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	038	0	1	01	01	H5928_038_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		60.00																								60.00																		30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	038	0	1	01	01	H5928_038_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	040	0	1	01	01	H5928_040_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	040	0	1	01	01	H5928_040_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					620.85	30		30																							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	040	0	1	01	01	H5928_040_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	1.67	50.00		100.00																								100.00																		50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	040	0	1	01	01	H5928_040_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		60.00																								60.00																		30.00				0.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	040	0	1	01	01	H5928_040_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	040	0	1	01	01	H5928_040_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	040	0	1	01	01	H5928_040_0	5	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.17	5.00		10.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5932	007	0	1	01	01	H5932_007_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31					1.00	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	007	0	1	01	01	H5932_007_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	007	0	1	01	01	H5932_007_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	007	0	1	01	01	H5932_007_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	007	0	1	01	01	H5932_007_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	007	0	1	01	01	H5932_007_0	4	6	Select Care Drugs	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	008	0	1	01	01	H5932_008_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31					1.00	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	008	0	1	01	01	H5932_008_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	008	0	1	01	01	H5932_008_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	008	0	1	01	01	H5932_008_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	008	0	1	01	01	H5932_008_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	008	0	1	01	01	H5932_008_0	4	6	Select Care Drugs	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5938	001	0	1	01	01	H5938_001_0	11	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	001	0	1	01	01	H5938_001_0	11	5	Specialty Tier	1	4	010010	1	4	010		01			1	30													30		31	8.33	250.00			250.00	25																																								250.00		25		8.06	250.00	25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	001	0	1	01	01	H5938_001_0	11	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00	160.00	200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	001	0	1	01	01	H5938_001_0	11	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.33	40.00	80.00	120.00																					1.33	40.00	80.00	100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	001	0	1	01	01	H5938_001_0	11	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.23	7.00	14.00	21.00																					.23	7.00	14.00	17.50																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	9	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5938	006	0	1	01	01	H5938_006_0	9	5	Specialty Tier	1	4	010010	1	4	010		01			1	30													30		31	8.33	250.00			250.00	25																																								250.00		25		8.06	250.00	25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	9	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00	160.00	200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.33	40.00	80.00	120.00																					1.33	40.00	80.00	100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.23	7.00	14.00	21.00																					.23	7.00	14.00	17.50																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	9	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.23	7.00	14.00	21.00																					.23	7.00	14.00	17.50																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5938	006	0	1	01	01	H5938_006_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5950	001	0	1	01	01	H5950_001_0	6	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.23	7.00	14.00	21.00																												.23	7.00	14.00	14.00				.23	7.00	14.00	21.00					7.00			.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5950	001	0	1	01	01	H5950_001_0	6	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5950	001	0	1	01	01	H5950_001_0	6	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5950	001	0	1	01	01	H5950_001_0	6	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5950	001	0	1	01	01	H5950_001_0	6	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.23	7.00	14.00	21.00					7.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5950	001	0	1	01	01	H5950_001_0	6	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.17	95.00	190.00	285.00																												3.17	95.00	190.00	190.00				3.17	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5969	001	0	1	01	01	H5969_001_0	13	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.83	85.00		255.00																					2.83	85.00		170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5969	001	0	1	01	01	H5969_001_0	13	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5969	001	0	1	01	01	H5969_001_0	13	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.13	4.00		12.00																					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5969	001	0	1	01	01	H5969_001_0	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.50	15.00		45.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5969	001	0	1	01	01	H5969_001_0	13	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.33	40.00		120.00																					1.33	40.00		80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	001	0	1	04	01	H5970_001_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	001	0	1	04	01	H5970_001_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5970	001	0	1	04	01	H5970_001_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5970	001	0	1	04	01	H5970_001_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	001	0	1	04	01	H5970_001_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	002	0	1	04	01	H5970_002_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	002	0	1	04	01	H5970_002_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		0.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	002	0	1	04	01	H5970_002_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	002	0	1	04	01	H5970_002_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	002	0	1	04	01	H5970_002_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	002	0	1	04	01	H5970_002_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5970	002	0	1	04	01	H5970_002_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		0.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5970	002	0	1	04	01	H5970_002_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	002	0	1	04	01	H5970_002_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	002	0	1	04	01	H5970_002_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	004	0	1	04	01	H5970_004_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	004	0	1	04	01	H5970_004_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	004	0	1	04	01	H5970_004_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	004	0	1	04	01	H5970_004_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5970	004	0	1	04	01	H5970_004_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5970	004	0	1	04	01	H5970_004_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	004	0	1	04	01	H5970_004_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	004	0	1	04	01	H5970_004_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	004	0	1	04	01	H5970_004_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	004	0	1	04	01	H5970_004_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	006	0	1	04	01	H5970_006_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	006	0	1	04	01	H5970_006_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	006	0	1	04	01	H5970_006_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5970	006	0	1	04	01	H5970_006_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5970	006	0	1	04	01	H5970_006_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	006	0	1	04	01	H5970_006_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	006	0	1	04	01	H5970_006_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	006	0	1	04	01	H5970_006_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	006	0	1	04	01	H5970_006_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	006	0	1	04	01	H5970_006_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	008	0	1	04	01	H5970_008_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	008	0	1	04	01	H5970_008_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	008	0	1	04	01	H5970_008_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	008	0	1	04	01	H5970_008_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	008	0	1	04	01	H5970_008_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5970	008	0	1	04	01	H5970_008_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5970	008	0	1	04	01	H5970_008_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	008	0	1	04	01	H5970_008_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	008	0	1	04	01	H5970_008_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	008	0	1	04	01	H5970_008_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	010	0	1	04	01	H5970_010_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	010	0	1	04	01	H5970_010_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	010	0	1	04	01	H5970_010_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	010	0	1	04	01	H5970_010_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5970	010	0	1	04	01	H5970_010_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	010	0	1	04	01	H5970_010_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	010	0	1	04	01	H5970_010_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	010	0	1	04	01	H5970_010_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	010	0	1	04	01	H5970_010_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	010	0	1	04	01	H5970_010_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H5985	001	0	1	01	01	H5985_001_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.45	45.00		112.50																					1.45	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.33	10.00		25.00																					.33	10.00		25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	10	4	Specialty Tier	1	4	000101	1	1	010		01	010		1	30							30						30		31					484.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	8	4	Specialty Tier	1	4	000101	1	1	010		01	010		1	30							30						30		31					484.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.45	45.00		112.50																					1.45	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.33	10.00		25.00																					.33	10.00		25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5989	002	0	1	01	01	H5989_002_0	6	4	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				2			90				30		31					1.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5989	002	0	1	01	01	H5989_002_0	6	3	Preferred Brand	1	3	100001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5989	002	0	1	01	01	H5989_002_0	6	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5989	002	0	1	01	01	H5989_002_0	6	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.24	7.25		21.75																								21.75																		7.25				0.23	7.25		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5989	008	0	1	01	01	H5989_008_0	5	3	Preferred Brand	1	3	100001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5989	008	0	1	01	01	H5989_008_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	.30	9.00		27.00																								27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5989	008	0	1	01	01	H5989_008_0	5	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	.13	4.00		12.00																								12.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5989	008	0	1	01	01	H5989_008_0	5	4	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				2			90				30		31					1.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	8	5	Specialty Tier	1	2	100000	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	8	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.74	85.00	170.00	255.00																					2.74	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	8	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	8	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.65	20.00	40.00	60.00																					.65	20.00	40.00	40.00																		20.00				.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	8	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	6	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.74	85.00	170.00	255.00																					2.74	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	6	5	Specialty Tier	1	2	100000	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	6	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	6	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.65	20.00	40.00	60.00																					.65	20.00	40.00	40.00																		20.00				.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	6	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5992	006	0	1	01	01	H5992_006_0	10	3	Specialty Tier	1	4	001001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					362.38	25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Specialty Tier												
H5992	006	0	1	01	01	H5992_006_0	10	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Specialty Tier												
H5992	006	0	1	01	01	H5992_006_0	10	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Specialty Tier												
H5992	006	0	1	01	01	H5992_006_0	10	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Specialty Tier										2		2
H5992	007	0	1	01	01	H5992_007_0	8	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Specialty Tier												
H5992	007	0	1	01	01	H5992_007_0	8	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Specialty Tier										2		2
H5992	007	0	1	01	01	H5992_007_0	8	3	Specialty Tier	1	4	001001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					380.63	25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Specialty Tier												
H5992	007	0	1	01	01	H5992_007_0	8	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Specialty Tier												
H6080	001	0	1	48	05	H6080_001_0	4	1	Generic Drugs	1	4	010000			110		01	100		1	31		90				2			90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H6080	001	0	1	48	05	H6080_001_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01	100		1	31		90				2			90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6080	001	0	1	48	05	H6080_001_0	4	2	Brand Drugs	1	4	000010			110		01	100		1	31		90				2			90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H6169	021	0	1	09	04	H6169_021_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	021	0	1	09	04	H6169_021_0	7	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	021	0	1	09	04	H6169_021_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	021	0	1	09	04	H6169_021_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	021	0	1	09	04	H6169_021_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	024	0	1	09	04	H6169_024_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.33	40.00		100.00																												1.33	40.00		40.00				1.33	40.00		100.00				40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	024	0	1	09	04	H6169_024_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.23	7.00		17.50																												.23	7.00		7.00				.23	7.00		17.50				7.00				.21	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	024	0	1	09	04	H6169_024_0	7	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.07	2.00		5.00																												.07	2.00		2.00				.07	2.00		5.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	024	0	1	09	04	H6169_024_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	2.67	80.00		200.00																												2.67	80.00		80.00				2.67	80.00		200.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	024	0	1	09	04	H6169_024_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					500.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	031	0	1	09	04	H6169_031_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	031	0	1	09	04	H6169_031_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	031	0	1	09	04	H6169_031_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	031	0	1	09	04	H6169_031_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	031	0	1	09	04	H6169_031_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	032	0	1	09	04	H6169_032_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	032	0	1	09	04	H6169_032_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	032	0	1	09	04	H6169_032_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	032	0	1	09	04	H6169_032_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	032	0	1	09	04	H6169_032_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	033	0	1	09	04	H6169_033_0	6	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	033	0	1	09	04	H6169_033_0	6	2	Non-Preferred Generic	1	3	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	033	0	1	09	04	H6169_033_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	033	0	1	09	04	H6169_033_0	6	4	Non-Preferred Brand	1	3	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	033	0	1	09	04	H6169_033_0	6	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	036	0	1	09	04	H6169_036_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34					435.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	036	0	1	09	04	H6169_036_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		110	1	30		90				2				30		90	30		34	3.17	95.00		237.50																												3.17	95.00		95.00				3.17	95.00		237.50				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	036	0	1	09	04	H6169_036_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		34	1.50	45.00		112.50																												1.50	45.00		45.00				1.50	45.00		112.50				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	036	0	1	09	04	H6169_036_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	.17	5.00		12.50																												.17	5.00		5.00				.17	5.00		12.50				5.00				.15	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6169	036	0	1	09	04	H6169_036_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	.40	12.00		30.00																												.40	12.00		12.00				.40	12.00		30.00				12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6178	001	0	1	01	01	H6178_001_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					531.70	25		25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6178	001	0	1	01	01	H6178_001_0	6	3	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	3.17	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6178	001	0	1	01	01	H6178_001_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6178	001	0	1	01	01	H6178_001_0	6	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6181	009	0	1	01	01	H6181_009_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	142.50	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6181	009	0	1	01	01	H6181_009_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	67.50	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6181	009	0	1	01	01	H6181_009_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	.13	4.00	8.00	12.00																					.13	4.00	6.00	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6181	009	0	1	01	01	H6181_009_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	62	93				1	31	62	93				31		31						33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6181	009	0	1	01	01	H6181_009_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.13	4.00	8.00	12.00																					.13	4.00	6.00	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6229	005	0	1	48	05	H6229_005_0	1	1	Generic Drugs	1	4	001001			111		10	100		1	31	62	93				2			93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6229	005	0	1	48	05	H6229_005_0	1	2	Brand Drugs	1	4	100100			111		10	100		1	31	62	93				2			93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs	1											
H6229	005	0	1	48	05	H6229_005_0	1	3	Non-Medicare Rx Generic Drugs	1	4	010000			111		10	100		1	31	62	93				2			93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6229	005	0	1	48	05	H6229_005_0	1	4	Non-Medicare Rx Brand Drugs	1	4	000010			111		10	100		1	31	62	93				2			93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6229	005	0	1	48	05	H6229_005_0	1	5	Non-Medicare OTC Generic Drugs	1	4	010000			010		10			1	31														10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H6237	002	0	1	01	01	H6237_002_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6237	002	0	1	01	01	H6237_002_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.66	20.00		60.00																					0.66	20.00		40.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6237	002	0	1	01	01	H6237_002_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6237	002	0	1	01	01	H6237_002_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6237	002	0	1	01	01	H6237_002_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					464.00	27																							27																			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	002	0	1	01	01	H6306_002_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00	160.00	200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	002	0	1	01	01	H6306_002_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					854.34	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	002	0	1	01	01	H6306_002_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.23	7.00	14.00	21.00																					.23	7.00	14.00	21.00																		7.00				.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6306	002	0	1	01	01	H6306_002_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.23	7.00	14.00	21.00																					0.22	7.00	0.00	0.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	002	0	1	01	01	H6306_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.83	25.00	50.00	75.00																					.83	25.00	50.00	62.50																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	002	0	1	01	01	H6306_002_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.33	40.00	80.00	120.00																					1.33	40.00	80.00	100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	7	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6328	001	0	1	04	01	H6328_001_0	7	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					29	31					400.00	33	33	33																					33	33	33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	2.16	65.00	130.00	162.50																					2.16	65.00	130.00	162.50																			65.00			2.10	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	7	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	1.10	33.00	66.00	82.50																					1.10	33.00	66.00	82.50																			33.00			1.05	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	.33	10.00	20.00	25.00																					.33	10.00	20.00	25.00																			10.00			.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					29	31					400.00	33	33	33																					33	33	33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	2.26	68.00	136.00	170.00																					2.26	68.00	136.00	170.00																			68.00			2.19	68.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	1.20	36.00	72.00	90.00																					1.20	36.00	72.00	90.00																			36.00			1.16	36.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	.40	12.00	24.00	30.00																					0.40	12.00	24.00	30.00																			12.00			0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6328	003	0	1	04	01	H6328_003_0	7	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	.13	4.00	8.00	10.00																					.13	4.00	8.00	10.00																			4.00			.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6328	003	0	1	04	01	H6328_003_0	7	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					29	31					400.00	33	33	33																					33	33	33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	2.33	70.00	140.00	175.00																					2.33	70.00	140.00	175.00																			70.00			2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	7	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	1.33	40.00	80.00	100.00																					1.33	40.00	80.00	100.00																			40.00			1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	7	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	.13	4.00	8.00	10.00																					.13	4.00	8.00	10.00																			4.00			.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	.50	15.00	30.00	37.50																					0.50	15.00	30.00	37.50																			15.00			0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6360	001	0	1	18	06	H6360_001_0	3	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	001	0	1	18	06	H6360_001_0	3	6	Vaccines	1	4	000001	1	2	010		01			1	31													31		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	001	0	1	18	06	H6360_001_0	3	6	Vaccines	3	4	000001	1	2	010		01			1	31													31		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	001	0	1	18	06	H6360_001_0	3	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	001	0	1	18	06	H6360_001_0	3	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	001	0	1	18	06	H6360_001_0	3	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	001	0	1	18	06	H6360_001_0	3	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	001	0	1	18	06	H6360_001_0	3	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.09	65.00		195.00																					2.09	65.00		130.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	001	0	1	18	06	H6360_001_0	3	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	31		90				1	31		90				31		31					622.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	3	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	002	0	1	18	06	H6360_002_0	3	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.16	5.00		15.00																					.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	3	6	Vaccines	3	4	000001	1	2	010		01			1	31													31		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	002	0	1	18	06	H6360_002_0	3	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					0.32	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	002	0	1	18	06	H6360_002_0	3	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					.32	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	3	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	3	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.09	65.00		195.00																					2.09	65.00		130.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	3	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	31		90				1	31		90				31		31					707.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	3	6	Vaccines	1	4	000001	1	2	010		01			1	31													31		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	006	0	1	18	06	H6360_006_0	3	6	Vaccines	1	3	000001	1	2	010		01			1	31													31		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	006	0	1	18	06	H6360_006_0	3	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	31		90				1	31		90				31		31					561.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	006	0	1	18	06	H6360_006_0	3	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.90	90.00		270.00																					2.90	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	006	0	1	18	06	H6360_006_0	3	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	006	0	1	18	06	H6360_006_0	3	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.54	17.00		51.00																					0.54	17.00		34.00																		17.00				0.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	006	0	1	18	06	H6360_006_0	3	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_0	3	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					0.32	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	009	0	2	18	06	H6360_009_0	3	6	Vaccines	3	4	000001	1	2	010		01			1	31													31		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	009	0	2	18	06	H6360_009_0	3	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	009	0	2	18	06	H6360_009_0	3	6	Vaccines	1	4	000001	1	2	010		01			1	31													31		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_0	3	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	31		90				1	31		90				31		31					459.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_0	3	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.09	65.00		195.00																					2.09	65.00		130.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_0	3	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_0	3	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_0	3	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		30.00																					0.32	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	010	0	1	18	06	H6360_010_0	5	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	31		90				1	31		90				31		31					735.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	010	0	1	18	06	H6360_010_0	5	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	31		90				1	31		90				31		31	3.06	95.00		285.00																					3.06	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	010	0	1	18	06	H6360_010_0	5	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	010	0	1	18	06	H6360_010_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.83	26.00		78.00																					0.83	26.00		52.00																		26.00				0.83	26.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	010	0	1	18	06	H6360_010_0	5	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.19	6.00		18.00																					0.19	6.00		12.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	010	0	1	18	06	H6360_010_0	5	6	Vaccines	1	3	000001	1	2	010		01	010		1	31							31						31		31	0.00	0.00																							0.00	0.00																				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6411	002	0	1	04	01	H6411_002_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6411	002	0	1	04	01	H6411_002_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6411	002	0	1	04	01	H6411_002_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6411	002	0	1	04	01	H6411_002_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6411	002	0	1	04	01	H6411_002_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6411	002	0	1	04	01	H6411_002_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6411	002	0	1	04	01	H6411_002_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6411	002	0	1	04	01	H6411_002_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6411	002	0	1	04	01	H6411_002_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6411	002	0	1	04	01	H6411_002_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6411	007	0	1	04	01	H6411_007_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6411	007	0	1	04	01	H6411_007_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6411	007	0	1	04	01	H6411_007_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6411	007	0	1	04	01	H6411_007_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6411	007	0	1	04	01	H6411_007_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6411	007	0	1	04	01	H6411_007_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6411	007	0	1	04	01	H6411_007_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6411	007	0	1	04	01	H6411_007_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6411	007	0	1	04	01	H6411_007_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6411	007	0	1	04	01	H6411_007_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6528	006	0	1	04	01	H6528_006_0	6	4	Non-Preferred Brand	1	4	100100	1	1	110		01		100	1	30		90				1						90	30		31					30.06	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															20.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	6	3	Preferred Brand	1	4	010001	1	1	110		01		100	1	30		90				1						90	30		31					18.63	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					544.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	016	0	1	04	01	H6528_016_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	016	0	1	04	01	H6528_016_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.30	9.00		27.00																															18.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	016	0	1	04	01	H6528_016_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	016	0	1	04	01	H6528_016_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	016	0	1	04	01	H6528_016_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					573.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	029	0	1	04	01	H6528_029_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					560.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	029	0	1	04	01	H6528_029_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	029	0	1	04	01	H6528_029_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	029	0	1	04	01	H6528_029_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.30	9.00		27.00																															18.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	029	0	1	04	01	H6528_029_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	030	0	1	04	01	H6528_030_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	030	0	1	04	01	H6528_030_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	030	0	1	04	01	H6528_030_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															20.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	030	0	1	04	01	H6528_030_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	030	0	1	04	01	H6528_030_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					766.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	003	0	1	04	01	H6609_003_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	003	0	1	04	01	H6609_003_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	003	0	1	04	01	H6609_003_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	003	0	1	04	01	H6609_003_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	003	0	1	04	01	H6609_003_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	005	0	1	04	01	H6609_005_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	005	0	1	04	01	H6609_005_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	005	0	1	04	01	H6609_005_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	005	0	1	04	01	H6609_005_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	005	0	1	04	01	H6609_005_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	005	0	1	04	01	H6609_005_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		0.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	005	0	1	04	01	H6609_005_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	005	0	1	04	01	H6609_005_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	005	0	1	04	01	H6609_005_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.66	20.00		60.00																												0.66	20.00		0.00				0.66	20.00		60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	005	0	1	04	01	H6609_005_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	009	0	1	04	01	H6609_009_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	009	0	1	04	01	H6609_009_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	009	0	1	04	01	H6609_009_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	009	0	1	04	01	H6609_009_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	009	0	1	04	01	H6609_009_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	009	0	1	04	01	H6609_009_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	009	0	1	04	01	H6609_009_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	009	0	1	04	01	H6609_009_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	009	0	1	04	01	H6609_009_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	009	0	1	04	01	H6609_009_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	011	0	1	04	01	H6609_011_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	011	0	1	04	01	H6609_011_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	011	0	1	04	01	H6609_011_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	011	0	1	04	01	H6609_011_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	011	0	1	04	01	H6609_011_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	011	0	1	04	01	H6609_011_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	011	0	1	04	01	H6609_011_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	011	0	1	04	01	H6609_011_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.46	44.00		132.00																												1.46	44.00		122.00				1.46	44.00		132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	011	0	1	04	01	H6609_011_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	011	0	1	04	01	H6609_011_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.46	44.00		132.00																												1.46	44.00		122.00				1.46	44.00		132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	013	0	1	04	01	H6609_013_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	013	0	1	04	01	H6609_013_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	013	0	1	04	01	H6609_013_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	013	0	1	04	01	H6609_013_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	013	0	1	04	01	H6609_013_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	013	0	1	04	01	H6609_013_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	013	0	1	04	01	H6609_013_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	013	0	1	04	01	H6609_013_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	013	0	1	04	01	H6609_013_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	013	0	1	04	01	H6609_013_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	017	0	1	04	01	H6609_017_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.30	9.00		27.00																												0.30	9.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	019	0	1	04	01	H6609_019_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	019	0	1	04	01	H6609_019_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	019	0	1	04	01	H6609_019_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	019	0	1	04	01	H6609_019_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	019	0	1	04	01	H6609_019_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	019	0	1	04	01	H6609_019_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	019	0	1	04	01	H6609_019_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	019	0	1	04	01	H6609_019_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	019	0	1	04	01	H6609_019_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	019	0	1	04	01	H6609_019_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	029	0	1	04	01	H6609_029_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	029	0	1	04	01	H6609_029_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	029	0	1	04	01	H6609_029_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	029	0	1	04	01	H6609_029_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	029	0	1	04	01	H6609_029_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	029	0	1	04	01	H6609_029_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	029	0	1	04	01	H6609_029_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	029	0	1	04	01	H6609_029_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	029	0	1	04	01	H6609_029_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	029	0	1	04	01	H6609_029_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	060	0	1	04	01	H6609_060_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	060	0	1	04	01	H6609_060_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	060	0	1	04	01	H6609_060_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	060	0	1	04	01	H6609_060_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	060	0	1	04	01	H6609_060_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	060	0	1	04	01	H6609_060_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	060	0	1	04	01	H6609_060_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	060	0	1	04	01	H6609_060_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	060	0	1	04	01	H6609_060_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	060	0	1	04	01	H6609_060_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	062	0	1	04	01	H6609_062_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	062	0	1	04	01	H6609_062_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	062	0	1	04	01	H6609_062_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	062	0	1	04	01	H6609_062_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	062	0	1	04	01	H6609_062_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	062	0	1	04	01	H6609_062_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	062	0	1	04	01	H6609_062_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	062	0	1	04	01	H6609_062_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	062	0	1	04	01	H6609_062_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	062	0	1	04	01	H6609_062_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	065	0	1	04	01	H6609_065_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	065	0	1	04	01	H6609_065_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	065	0	1	04	01	H6609_065_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	065	0	1	04	01	H6609_065_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	065	0	1	04	01	H6609_065_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	065	0	1	04	01	H6609_065_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	065	0	1	04	01	H6609_065_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	065	0	1	04	01	H6609_065_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	065	0	1	04	01	H6609_065_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	065	0	1	04	01	H6609_065_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	066	0	1	04	01	H6609_066_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	066	0	1	04	01	H6609_066_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	066	0	1	04	01	H6609_066_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	066	0	1	04	01	H6609_066_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	066	0	1	04	01	H6609_066_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	066	0	1	04	01	H6609_066_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	066	0	1	04	01	H6609_066_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	066	0	1	04	01	H6609_066_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	066	0	1	04	01	H6609_066_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	066	0	1	04	01	H6609_066_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	074	0	1	04	01	H6609_074_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	074	0	1	04	01	H6609_074_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	074	0	1	04	01	H6609_074_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	074	0	1	04	01	H6609_074_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	074	0	1	04	01	H6609_074_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	075	0	1	04	01	H6609_075_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	075	0	1	04	01	H6609_075_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	075	0	1	04	01	H6609_075_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	075	0	1	04	01	H6609_075_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	075	0	1	04	01	H6609_075_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	075	0	1	04	01	H6609_075_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	075	0	1	04	01	H6609_075_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	075	0	1	04	01	H6609_075_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	075	0	1	04	01	H6609_075_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	075	0	1	04	01	H6609_075_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	076	0	1	04	01	H6609_076_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	076	0	1	04	01	H6609_076_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	076	0	1	04	01	H6609_076_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	076	0	1	04	01	H6609_076_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	076	0	1	04	01	H6609_076_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	076	0	1	04	01	H6609_076_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	076	0	1	04	01	H6609_076_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	076	0	1	04	01	H6609_076_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	076	0	1	04	01	H6609_076_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	076	0	1	04	01	H6609_076_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.16	35.00		105.00																												1.16	35.00		95.00				1.16	35.00		105.00				35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	077	0	1	04	01	H6609_077_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	077	0	1	04	01	H6609_077_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	077	0	1	04	01	H6609_077_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	077	0	1	04	01	H6609_077_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	078	0	1	04	01	H6609_078_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	078	0	1	04	01	H6609_078_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	078	0	1	04	01	H6609_078_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	078	0	1	04	01	H6609_078_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	078	0	1	04	01	H6609_078_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	078	0	1	04	01	H6609_078_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	079	0	1	04	01	H6609_079_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	079	0	1	04	01	H6609_079_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	079	0	1	04	01	H6609_079_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	079	0	1	04	01	H6609_079_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	079	0	1	04	01	H6609_079_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	079	0	1	04	01	H6609_079_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	079	0	1	04	01	H6609_079_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	079	0	1	04	01	H6609_079_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	079	0	1	04	01	H6609_079_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	079	0	1	04	01	H6609_079_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	080	0	1	04	01	H6609_080_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	080	0	1	04	01	H6609_080_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	080	0	1	04	01	H6609_080_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	080	0	1	04	01	H6609_080_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	080	0	1	04	01	H6609_080_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	080	0	1	04	01	H6609_080_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	081	0	1	04	01	H6609_081_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	081	0	1	04	01	H6609_081_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	081	0	1	04	01	H6609_081_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	081	0	1	04	01	H6609_081_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	081	0	1	04	01	H6609_081_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	081	0	1	04	01	H6609_081_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	081	0	1	04	01	H6609_081_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	081	0	1	04	01	H6609_081_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	081	0	1	04	01	H6609_081_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	081	0	1	04	01	H6609_081_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	082	0	1	04	01	H6609_082_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	082	0	1	04	01	H6609_082_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	082	0	1	04	01	H6609_082_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	082	0	1	04	01	H6609_082_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	082	0	1	04	01	H6609_082_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	083	0	1	04	01	H6609_083_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	083	0	1	04	01	H6609_083_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	083	0	1	04	01	H6609_083_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	083	0	1	04	01	H6609_083_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	083	0	1	04	01	H6609_083_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	083	0	1	04	01	H6609_083_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	084	0	1	04	01	H6609_084_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	084	0	1	04	01	H6609_084_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	084	0	1	04	01	H6609_084_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	084	0	1	04	01	H6609_084_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	084	0	1	04	01	H6609_084_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	084	0	1	04	01	H6609_084_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	084	0	1	04	01	H6609_084_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	084	0	1	04	01	H6609_084_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	084	0	1	04	01	H6609_084_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	084	0	1	04	01	H6609_084_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	085	0	1	04	01	H6609_085_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	085	0	1	04	01	H6609_085_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	085	0	1	04	01	H6609_085_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	085	0	1	04	01	H6609_085_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	085	0	1	04	01	H6609_085_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	085	0	1	04	01	H6609_085_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	085	0	1	04	01	H6609_085_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	085	0	1	04	01	H6609_085_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	085	0	1	04	01	H6609_085_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	085	0	1	04	01	H6609_085_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	086	0	1	04	01	H6609_086_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	086	0	1	04	01	H6609_086_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	086	0	1	04	01	H6609_086_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	086	0	1	04	01	H6609_086_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	086	0	1	04	01	H6609_086_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	086	0	1	04	01	H6609_086_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6609	086	0	1	04	01	H6609_086_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	086	0	1	04	01	H6609_086_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	086	0	1	04	01	H6609_086_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	086	0	1	04	01	H6609_086_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	087	0	1	04	01	H6609_087_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	087	0	1	04	01	H6609_087_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	087	0	1	04	01	H6609_087_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	087	0	1	04	01	H6609_087_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	087	0	1	04	01	H6609_087_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	087	0	1	04	01	H6609_087_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	087	0	1	04	01	H6609_087_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	087	0	1	04	01	H6609_087_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	087	0	1	04	01	H6609_087_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	087	0	1	04	01	H6609_087_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6622	001	0	1	01	01	H6622_001_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	001	0	1	01	01	H6622_001_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	001	0	1	01	01	H6622_001_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	001	0	1	01	01	H6622_001_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	001	0	1	01	01	H6622_001_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6622	001	0	1	01	01	H6622_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	002	0	1	01	01	H6622_002_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	002	0	1	01	01	H6622_002_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6622	002	0	1	01	01	H6622_002_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	002	0	1	01	01	H6622_002_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	002	0	1	01	01	H6622_002_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	003	0	1	01	01	H6622_003_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	003	0	1	01	01	H6622_003_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	003	0	1	01	01	H6622_003_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	003	0	1	01	01	H6622_003_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	003	0	1	01	01	H6622_003_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6622	003	0	1	01	01	H6622_003_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	003	0	1	01	01	H6622_003_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	003	0	1	01	01	H6622_003_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	003	0	1	01	01	H6622_003_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	003	0	1	01	01	H6622_003_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	001	0	1	04	01	H6743_001_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.32	10.00		20.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	001	0	1	04	01	H6743_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.64	20.00		40.00																					.64	20.00		40.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	001	0	1	04	01	H6743_001_0	8	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	31		90				1	31		90				31		31					200.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	001	0	1	04	01	H6743_001_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		90				1	31		90				31		31	3.06	95.00		190.00																					3.06	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	001	0	1	04	01	H6743_001_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		90.00																					1.45	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	003	0	1	04	01	H6743_003_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.19	6.00		12.00																					.19	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	003	0	1	04	01	H6743_003_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.48	15.00		30.00																					.48	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	003	0	1	04	01	H6743_003_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		80.00																					1.29	40.00		80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	003	0	1	04	01	H6743_003_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.74	85.00		170.00																					2.74	85.00		170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	003	0	1	04	01	H6743_003_0	7	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	31		90				1	31		90				31		31						29		29																					29		29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	004	0	1	04	01	H6743_004_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.12	4.00		8.00																					.12	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	004	0	1	04	01	H6743_004_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.12	35.00		70.00																					1.12	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	004	0	1	04	01	H6743_004_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.41	75.00		150.00																					2.41	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	004	0	1	04	01	H6743_004_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		20.00																					0.32	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	004	0	1	04	01	H6743_004_0	7	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	31		90				1	31		90				31		31					200.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	005	0	1	04	01	H6743_005_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.12	4.00		8.00																					.12	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	005	0	1	04	01	H6743_005_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.12	35.00		70.00																					1.12	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	005	0	1	04	01	H6743_005_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.41	75.00		150.00																					2.41	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	005	0	1	04	01	H6743_005_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		20.00																					0.32	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	005	0	1	04	01	H6743_005_0	8	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	31		90				1	31		90				31		31					200.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	007	0	1	04	01	H6743_007_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.32	10.00		20.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	007	0	1	04	01	H6743_007_0	7	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	31		90				1	31		90				31		31					200.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	007	0	1	04	01	H6743_007_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.64	20.00		40.00																					.64	20.00		40.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	007	0	1	04	01	H6743_007_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		90				1	31		90				31		31	3.06	95.00		190.00																					3.06	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6743	007	0	1	04	01	H6743_007_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		90.00																					1.45	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6745	001	0	1	01	01	H6745_001_0	8	3	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	33	33	33																					33	33	33																	33				33	Generic, Brand, Specialty Tier												
H6745	001	0	1	01	01	H6745_001_0	8	1	Generic	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Generic, Brand, Specialty Tier												
H6745	001	0	1	01	01	H6745_001_0	8	2	Brand	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Generic, Brand, Specialty Tier												
H6750	001	0	1	01	01	H6750_001_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				1	30		90				30		31	0.10	3.00	6.00	9.00																					.08	2.50		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H6750	001	0	1	01	01	H6750_001_0	10	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				1	30		90				30		31	.33	10.00	20.00	30.00																					0.30	9.00		27.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand										1		
H6750	001	0	1	01	01	H6750_001_0	10	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				1	30		90				30		31	.10	3.00	6.00	9.00																					.08	2.50		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand										1		
H6750	001	0	1	01	01	H6750_001_0	10	4	Non-Preferred Brand	1	4	100000	1	1	111		01	110		1	30	60	90				1	30		90				30		31					42.09	40	40	40																					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H6750	001	0	1	01	01	H6750_001_0	10	3	Preferred Brand	1	4	000001	1	1	111		01	110		1	30	60	90				1	30		90				30		31					37.70	25	25	25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H6750	001	0	1	01	01	H6750_001_0	10	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				1	30		90				30		31	0.33	10.00	20.00	30.00																					.30	9.00		27.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
H6751	001	0	1	48	05	H6751_001_0	7	2	Brand Drugs	1	4	000010			111		01	110		1	30	60	90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6751	001	0	1	48	05	H6751_001_0	7	1	Generic Drugs	1	4	010000			111		01	110		1	30	60	90				2	30		90				30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6786	001	0	1	04	01	H6786_001_0	7	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H6786	001	0	1	04	01	H6786_001_0	7	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H6786	001	0	1	04	01	H6786_001_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H6786	001	0	1	04	01	H6786_001_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H6786	001	0	1	04	01	H6786_001_0	7	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.53	18.00	36.00	54.00					.68	23.00	46.00	69.00					.53	18.00	36.00	36.00																		23.00				.68	23.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H6786	001	0	1	04	01	H6786_001_0	7	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	10	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	0.00	0.00		0.00																								0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	0.16	5.00		15.00																								15.00																			5.00			.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	10	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	1.06	32.00		96.00																								96.00																			32.00			1.03	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	0.16	5.00		15.00																								15.00																			5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6801	002	0	1	01	01	H6801_002_0	10	5	Specialty Tier	1	4	000010	1	1	110		10	100		1	30		90				1			90					29	31						33		33																							33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	10	1	Preferred Generic	3	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	0.00	0.00		0.00																								0.00																			0.00			0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6801	002	0	1	01	01	H6801_002_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	3.00	90.00		270.00																								270.00																			90.00			2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6815	001	0	1	01	01	H6815_001_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.13	4.00	8.00	12.00																												0.13	4.00	8.00	8.00				0.13	4.00	8.00	12.00				4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	001	0	1	01	01	H6815_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	20.00				0.33	10.00	20.00	30.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	001	0	1	01	01	H6815_001_0	4	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.26	38.00	76.00	114.00																												1.26	38.00	76.00	76.00				1.26	38.00	76.00	114.00				38.00				1.11	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	001	0	1	01	01	H6815_001_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	238.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	001	0	1	01	01	H6815_001_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					273.44	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	001	0	1	01	01	H6815_001_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	002	0	1	01	01	H6815_002_0	4	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.13	4.00	8.00	12.00																												0.13	4.00	8.00	8.00				0.13	4.00	8.00	12.00				4.00				0.11	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	002	0	1	01	01	H6815_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.33	10.00	20.00	30.00																												0.33	10.00	20.00	20.00				0.33	10.00	20.00	30.00				10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	002	0	1	01	01	H6815_002_0	4	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	1.26	38.00	76.00	114.00																												1.26	38.00	76.00	76.00				1.26	38.00	76.00	114.00				38.00				1.11	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	002	0	1	01	01	H6815_002_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	238.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	002	0	1	01	01	H6815_002_0	4	5	Specialty Tier	1	4	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		34					323.73	33	33	33																												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	002	0	1	01	01	H6815_002_0	4	6	Select Care Drugs	1	4	010010	1	2	111		01		111	1	30	60	90				1				30	60	90	30		34	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				0.00	0.00	0.00	0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6859	001	0	1	01	01	H6859_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	001	0	1	01	01	H6859_001_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	001	0	1	01	01	H6859_001_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	001	0	1	01	01	H6859_001_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	001	0	1	01	01	H6859_001_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	001	0	1	01	01	H6859_001_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6859	001	0	1	01	01	H6859_001_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6859	001	0	1	01	01	H6859_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	001	0	1	01	01	H6859_001_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	001	0	1	01	01	H6859_001_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	002	0	1	01	01	H6859_002_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	002	0	1	01	01	H6859_002_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	002	0	1	01	01	H6859_002_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	002	0	1	01	01	H6859_002_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6859	002	0	1	01	01	H6859_002_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	002	0	1	01	01	H6859_002_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	002	0	1	01	01	H6859_002_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	002	0	1	01	01	H6859_002_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	002	0	1	01	01	H6859_002_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	002	0	1	01	01	H6859_002_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6859	003	0	1	01	01	H6859_003_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	003	0	1	01	01	H6859_003_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	003	0	1	01	01	H6859_003_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	003	0	1	01	01	H6859_003_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	003	0	1	01	01	H6859_003_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	003	0	1	01	01	H6859_003_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	003	0	1	01	01	H6859_003_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	003	0	1	01	01	H6859_003_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	003	0	1	01	01	H6859_003_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6859	003	0	1	01	01	H6859_003_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6859	004	0	1	01	01	H6859_004_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	004	0	1	01	01	H6859_004_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	004	0	1	01	01	H6859_004_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	004	0	1	01	01	H6859_004_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	004	0	1	01	01	H6859_004_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	004	0	1	01	01	H6859_004_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6859	004	0	1	01	01	H6859_004_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6859	004	0	1	01	01	H6859_004_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	004	0	1	01	01	H6859_004_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	004	0	1	01	01	H6859_004_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	005	0	1	01	01	H6859_005_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	005	0	1	01	01	H6859_005_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	005	0	1	01	01	H6859_005_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H6859	005	0	1	01	01	H6859_005_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6859	005	0	1	01	01	H6859_005_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	005	0	1	01	01	H6859_005_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	005	0	1	01	01	H6859_005_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	005	0	1	01	01	H6859_005_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	005	0	1	01	01	H6859_005_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	005	0	1	01	01	H6859_005_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6881	002	0	1	04	01	H6881_002_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.83	85.00		255.00																					2.83	85.00		212.50																		85.00				2.74	85.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6881	002	0	1	04	01	H6881_002_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6881	002	0	1	04	01	H6881_002_0	5	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.13	4.00		12.00																					0.13	4.00		10.00																		4.00				0.12	4.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6881	002	0	1	04	01	H6881_002_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6923	001	0	1	01	01	H6923_001_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6923	001	0	1	01	01	H6923_001_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					88.84	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6923	001	0	1	01	01	H6923_001_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					33.43	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6923	001	0	1	01	01	H6923_001_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6923	001	0	1	01	01	H6923_001_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6923	001	0	1	01	01	H6923_001_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6923	005	0	1	01	01	H6923_005_0	6	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6923	005	0	1	01	01	H6923_005_0	6	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6923	005	0	1	01	01	H6923_005_0	6	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6923	005	0	1	01	01	H6923_005_0	6	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					35.01	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6923	005	0	1	01	01	H6923_005_0	6	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6923	005	0	1	01	01	H6923_005_0	6	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.81	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6951	002	0	1	04	01	H6951_002_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.06	2.00	4.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6951	002	0	1	04	01	H6951_002_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					555.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6951	002	0	1	04	01	H6951_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6951	002	0	1	04	01	H6951_002_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6951	002	0	1	04	01	H6951_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.58	18.00	36.00	54.00																					0.58	18.00	36.00	54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6951	003	0	1	04	01	H6951_003_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					555.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6951	003	0	1	04	01	H6951_003_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6951	003	0	1	04	01	H6951_003_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6951	003	0	1	04	01	H6951_003_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.06	2.00	4.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6951	003	0	1	04	01	H6951_003_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.58	18.00	36.00	54.00																					0.58	18.00	36.00	54.00																		18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6972	001	0	1	01	01	H6972_001_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00		275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6972	001	0	1	01	01	H6972_001_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6972	001	0	1	01	01	H6972_001_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.36	11.00	22.00	33.00																					0.36	11.00		24.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6972	001	0	1	01	01	H6972_001_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.06	2.00	4.00	6.00																					0.06	2.00		0.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6972	001	0	1	01	01	H6972_001_0	3	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					596.18	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7002	002	0	1	04	01	H7002_002_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H7002	002	0	1	04	01	H7002_002_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7002	002	0	1	04	01	H7002_002_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H7002	002	0	1	04	01	H7002_002_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H7002	002	0	1	04	01	H7002_002_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7002	002	0	1	04	01	H7002_002_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7002	002	0	1	04	01	H7002_002_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H7002	002	0	1	04	01	H7002_002_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H7002	002	0	1	04	01	H7002_002_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7002	002	0	1	04	01	H7002_002_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	001	0	1	04	01	H7006_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.12	4.00		8.00																					.12	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	001	0	1	04	01	H7006_001_0	6	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	31		90				1	31		90				31		31					200.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	001	0	1	04	01	H7006_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.41	75.00		150.00																					2.41	75.00		150.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	001	0	1	04	01	H7006_001_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.12	35.00		70.00																					1.12	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	001	0	1	04	01	H7006_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	0.32	10.00		20.00																					0.32	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	003	0	1	04	01	H7006_003_0	5	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	31		90				1	31		90				31		31						29		29																					29		29																	29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	003	0	1	04	01	H7006_003_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.29	40.00		80.00																					1.29	40.00		80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	003	0	1	04	01	H7006_003_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.48	15.00		30.00																					.48	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	003	0	1	04	01	H7006_003_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		90				1	31		90				31		31	2.74	85.00		170.00																					2.74	85.00		170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	003	0	1	04	01	H7006_003_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.19	6.00		12.00																					.19	6.00		12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	005	0	1	04	01	H7006_005_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.32	10.00		20.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	005	0	1	04	01	H7006_005_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	.64	20.00		40.00																					.64	20.00		40.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	005	0	1	04	01	H7006_005_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		90.00																					1.45	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	005	0	1	04	01	H7006_005_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		90				1	31		90				31		31	3.06	95.00		190.00																					3.06	95.00		190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	005	0	1	04	01	H7006_005_0	6	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	31		90				1	31		90				31		31					200.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7020	001	0	1	01	01	H7020_001_0	6	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7020	001	0	1	01	01	H7020_001_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7020	001	0	1	01	01	H7020_001_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					484.67	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7020	001	0	1	01	01	H7020_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7020	001	0	1	01	01	H7020_001_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7020	001	0	1	01	01	H7020_001_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7020	001	0	1	01	01	H7020_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7086	001	0	1	01	01	H7086_001_0	5	1	Generic	1	4	010000	1	2	110		01	100		1	31		93				1			93				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Brand												
H7086	001	0	1	01	01	H7086_001_0	5	2	Brand	1	4	000010	1	2	110		01	100		1	31		93				1			93				31		31	1.93	60.00		180.00																								180.00																		60.00				1.93	60.00		Generic, Brand												
H7149	001	0	1	01	01	H7149_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.13	4.00	8.00	12.00					.30	9.00	18.00	27.00					.13	4.00	8.00	12.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.30	9.00	18.00	27.00					.40	12.00	24.00	36.00					.30	9.00	18.00	27.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.10	3.00	6.00	9.00					.23	7.00	14.00	21.00					.10	3.00	6.00	9.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.23	7.00	14.00	21.00					.33	10.00	20.00	30.00					.23	7.00	14.00	21.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.33	40.00	80.00	120.00					1.43	43.00	86.00	129.00					1.33	40.00	80.00	120.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.66	80.00	160.00	240.00					2.76	83.00	166.00	249.00					2.66	80.00	160.00	240.00																		83.00				2.67	83.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7172	001	0	1	48	05	H7172_001_0	3	1	Generic Drugs	1	4	010000			111		10	111		1	30	60	90				1	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1											
H7172	001	0	1	48	05	H7172_001_0	3	2	Brand Drugs	1	4	000010			111		10	111		1	30	60	90				1	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1											
H7172	001	0	1	48	05	H7172_001_0	3	4	Non-Medicare Rx Brand Drugs	1	4	000010			111		10	111		1	30	60	90				1	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7172	001	0	1	48	05	H7172_001_0	3	3	Non-Medicare Rx Generic Drugs	1	4	010000			111		10	111		1	30	60	90				1	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7172	001	0	1	48	05	H7172_001_0	3	5	Non-Medicare OTC Drugs	1	4	010010			111		10	111		1	30	60	90				1	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7173	001	0	1	01	01	H7173_001_0	7	4	Injectable Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H7173	001	0	1	01	01	H7173_001_0	7	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H7173	001	0	1	01	01	H7173_001_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.45	45.00		45.00																								45.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H7173	001	0	1	01	01	H7173_001_0	7	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H7187	003	0	1	01	01	H7187_003_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	003	0	1	01	01	H7187_003_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					632.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	003	0	1	01	01	H7187_003_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	003	0	1	01	01	H7187_003_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	003	0	1	01	01	H7187_003_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	009	0	1	01	01	H7187_009_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					536.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	009	0	1	01	01	H7187_009_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	009	0	1	01	01	H7187_009_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	009	0	1	01	01	H7187_009_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	009	0	1	01	01	H7187_009_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7188	003	0	1	04	01	H7188_003_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7188	003	0	1	04	01	H7188_003_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.36	11.00		33.00																												0.36	11.00		0.00				0.36	11.00		33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7188	003	0	1	04	01	H7188_003_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7188	003	0	1	04	01	H7188_003_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H7188	003	0	1	04	01	H7188_003_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7188	003	0	1	04	01	H7188_003_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H7188	003	0	1	04	01	H7188_003_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.36	11.00		33.00																												0.36	11.00		0.00				0.36	11.00		33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H7188	003	0	1	04	01	H7188_003_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H7188	003	0	1	04	01	H7188_003_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7188	003	0	1	04	01	H7188_003_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H7188	006	0	1	04	01	H7188_006_0	6	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.00	90.00		270.00					3.16	95.00		285.00												3.00	90.00		260.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H7188	006	0	1	04	01	H7188_006_0	6	3	Preferred Brand	3	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	15		15					32.00	25		25												15		15					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H7188	006	0	1	04	01	H7188_006_0	6	2	Non-Preferred Generic	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.26	8.00		24.00												0.10	3.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H7188	006	0	1	04	01	H7188_006_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	31							1.00	31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7188	006	0	1	04	01	H7188_006_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.20	6.00		18.00												0.03	1.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7188	006	0	1	04	01	H7188_006_0	6	5	Specialty Tier	3	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	31							1.00	31														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H7188	006	0	1	04	01	H7188_006_0	6	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													13.00	15		15					23.00	25		25												15		15					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7188	006	0	1	04	01	H7188_006_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													41.00	30		30					70.00	50		50												30		30					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7188	006	0	1	04	01	H7188_006_0	6	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.26	8.00		24.00												0.10	3.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7200	007	0	1	01	01	H7200_007_0	5	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.13	4.00	8.00	12.00																					.13	4.00	6.00	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7200	007	0	1	01	01	H7200_007_0	5	2	Non-Preferred Generic	1	3	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.97	30.00	60.00	90.00																					.97	30.00	45.00	60.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7200	007	0	1	01	01	H7200_007_0	5	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	67.50	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7200	007	0	1	01	01	H7200_007_0	5	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	142.50	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7200	007	0	1	01	01	H7200_007_0	5	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31						33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	003	0	1	01	01	H7220_003_0	6	5	Specialty Tier	1	4	100000	1	1	010		10	010		1	31							31							29	31					789.18	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	003	0	1	01	01	H7220_003_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		90				2	31		90				31		31	3.06	95.00		266.00																					3.06	95.00		266.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	003	0	1	01	01	H7220_003_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				2	31		90				31		31	1.45	45.00		126.00																					1.45	45.00		126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	003	0	1	01	01	H7220_003_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				2	31		90				31		31	.19	6.00		18.00																					.19	6.00		18.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	003	0	1	01	01	H7220_003_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				2	31		90				31		31	.48	15.00		44.00																					.48	15.00		44.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	31		90				2	31		90				31		31	3.06	95.00		266.00																					3.06	95.00		266.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	31		90				2	31		90				31		31	1.35	42.00		118.00																					1.35	42.00		118.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	7	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	31		90				2	31		90				31		31	.48	15.00		42.00																					.48	15.00		42.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				2	31		90				31		31	.19	6.00		16.00																					.19	6.00		16.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				2	31		90				31		31	.32	10.00		30.00																					.32	10.00		30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7220	004	0	1	02	01	H7220_004_0	7	5	Specialty Tier	1	4	100000	1	1	010		10	010		1	31							31							29	31					789.18	33																							33																				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	10	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	10	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34													61.14	33							61.14	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	10	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.00	90.00	180.00	270.00					3.00	90.00	180.00	270.00												3.00	90.00	180.00	270.00				3.00	90.00	180.00	270.00				90.00				2.64	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	10	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	10	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.30	9.00	18.00	27.00					.50	15.00	30.00	45.00												.30	9.00	18.00	27.00				.50	15.00	30.00	45.00				15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	10	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.13	4.00	8.00	12.00					.30	9.00	18.00	27.00												.13	4.00	8.00	12.00				.30	9.00	18.00	27.00				9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	002	0	1	02	01	H7245_002_0	10	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.00	90.00	180.00	270.00					3.00	90.00	180.00	270.00												3.00	90.00	180.00	270.00				3.00	90.00	180.00	270.00				90.00				2.64	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	002	0	1	02	01	H7245_002_0	10	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	002	0	1	02	01	H7245_002_0	10	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.30	9.00	18.00	27.00					.50	15.00	30.00	45.00												.30	9.00	18.00	27.00				.50	15.00	30.00	45.00				15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	002	0	1	02	01	H7245_002_0	10	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.13	4.00	8.00	12.00					.30	9.00	18.00	27.00												.13	4.00	8.00	12.00				.30	9.00	18.00	27.00				9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	002	0	1	02	01	H7245_002_0	10	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	002	0	1	02	01	H7245_002_0	10	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34													61.14	33							61.14	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	10	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	10	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34													61.14	33							61.14	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	10	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									2.66	80.00	160.00	240.00					2.66	80.00	160.00	240.00												2.66	80.00	160.00	240.00				2.66	80.00	160.00	240.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	10	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.16	35.00	70.00	105.00					1.16	35.00	70.00	105.00												1.16	35.00	70.00	105.00				1.16	35.00	70.00	105.00				35.00				1.02	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	10	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.26	8.00	16.00	24.00					.50	15.00	30.00	45.00												.26	8.00	16.00	24.00				.50	15.00	30.00	45.00				15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	10	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.10	3.00	6.00	9.00					.30	9.00	18.00	27.00												.10	3.00	6.00	9.00				.30	9.00	18.00	27.00				9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	004	0	1	02	01	H7245_004_0	10	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	004	0	1	02	01	H7245_004_0	10	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									2.66	80.00	160.00	240.00					2.66	80.00	160.00	240.00												2.66	80.00	160.00	240.00				2.66	80.00	160.00	240.00				80.00				2.35	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	004	0	1	02	01	H7245_004_0	10	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.16	35.00	70.00	105.00					1.16	35.00	70.00	105.00												1.16	35.00	70.00	105.00				1.16	35.00	70.00	105.00				35.00				1.02	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	004	0	1	02	01	H7245_004_0	10	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.26	8.00	16.00	24.00					.50	15.00	30.00	45.00												.26	8.00	16.00	24.00				.50	15.00	30.00	45.00				15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	004	0	1	02	01	H7245_004_0	10	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									.10	3.00	6.00	9.00					.30	9.00	18.00	27.00												.10	3.00	6.00	9.00				.30	9.00	18.00	27.00				9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	004	0	1	02	01	H7245_004_0	10	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34													61.14	33							61.14	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	10	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.33	10.00	20.00	30.00					1.10	33.00	66.00	99.00					0.33	10.00	20.00	30.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	10	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	10	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					0.33	10.00	20.00	30.00					0.00	0.00	0.00	0.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7306	001	0	1	04	01	H7306_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.00	0.00	0.00	0.00					0.10	3.00	6.00	9.00					0.00	0.00	0.00	0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7306	001	0	1	04	01	H7306_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.10	3.00	6.00	9.00					.33	10.00	20.00	30.00					0.10	3.00	3.00	3.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7306	001	0	1	04	01	H7306_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7306	001	0	1	04	01	H7306_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.33	70.00	140.00	140.00					3.16	95.00	190.00	190.00					2.33	70.00	140.00	140.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7306	001	0	1	04	01	H7306_001_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	70.00					1.50	45.00	90.00	90.00					1.16	35.00	70.00	70.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7419	001	0	1	48	05	H7419_001_0	4	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7419	001	0	1	48	05	H7419_001_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7419	001	0	1	48	05	H7419_001_0	4	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7678	001	0	1	01	01	H7678_001_0	8	1	Generic	1	4	010000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	8	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	8	1	Generic	3	4	010000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7678	001	0	1	01	01	H7678_001_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31						25																							25																			25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	8	3	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7728	001	0	1	04	01	H7728_001_0	5	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7728	001	0	1	04	01	H7728_001_0	5	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7728	001	0	1	04	01	H7728_001_0	5	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7728	001	0	1	04	01	H7728_001_0	5	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7728	001	0	1	04	01	H7728_001_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.53	18.00	36.00	54.00					.68	23.00	46.00	69.00					.53	18.00	36.00	36.00																		23.00				.68	23.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7728	001	0	1	04	01	H7728_001_0	5	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					501.07	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.33	70.00	140.00	210.00																					2.33	70.00		200.00																		70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.16	35.00	70.00	105.00																					1.16	35.00		95.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.26	8.00	16.00	24.00																					0.26	8.00		15.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7811	001	0	1	01	01	H7811_001_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7811	001	0	1	01	01	H7811_001_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.36	11.00	22.00	33.00																					0.36	11.00		24.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7811	001	0	1	01	01	H7811_001_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.06	2.00	4.00	6.00																					0.06	2.00		0.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7811	001	0	1	01	01	H7811_001_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00		275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7811	001	0	1	01	01	H7811_001_0	3	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					578.08	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7811	002	0	1	01	01	H7811_002_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7811	002	0	1	01	01	H7811_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.36	11.00	22.00	33.00																					0.36	11.00		24.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7811	002	0	1	01	01	H7811_002_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.06	2.00	4.00	6.00																					0.06	2.00		0.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7811	002	0	1	01	01	H7811_002_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00		275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7811	002	0	1	01	01	H7811_002_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					578.08	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7885	001	0	1	48	05	H7885_001_0	4	2	Brand Drugs	1	4	000010			110		01			1	31		93				1							31		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00			0.00	0.00			
H7885	001	0	1	48	05	H7885_001_0	4	1	Generic Drugs	1	4	010000			110		01			1	31		93				1							31		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00			0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	5	1	Generic Drugs	1	4	010000			110		01	110		1	31		90				1	31		90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	5	2	Brand Drugs	1	4	000010			110		01	110		1	31		90				1	31		90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	5	3	Non-Medicare Rx Generic Drugs	1	4	001000			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	5	4	Non-Medicare Rx Brand Drugs	1	4	000001			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	5	5	Non-Medicare OTC Drugs	1	4	100000			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7908	001	0	1	01	01	H7908_001_0	5	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.64	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7908	001	0	1	01	01	H7908_001_0	5	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					73.37	50	50	50																												50	50	50					50	50	50				50			50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7908	001	0	1	01	01	H7908_001_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7908	001	0	1	01	01	H7908_001_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7908	001	0	1	01	01	H7908_001_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.33	10.00	20.00	30.00					10.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7908	001	0	1	01	01	H7908_001_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.33	10.00	20.00	30.00																												.33	10.00	20.00	20.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7917	008	0	1	04	01	H7917_008_0	6	1	Generic	1	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	6	2	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		75.00																		30.00				.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	1.66	50.00		150.00																					1.66	50.00		125.00																		50.00				1.61	50.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	6	1	Generic	1	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	1.66	50.00		150.00																					1.66	50.00		125.00																		50.00				1.61	50.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	6	2	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		75.00																		30.00				.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	1.66	50.00		150.00																					1.66	50.00		125.00																		50.00				1.61	50.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	6	2	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		75.00																		30.00				.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	6	1	Generic	1	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	6	1	Generic	1	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	6	2	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		75.00																		30.00				.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	1.66	50.00		150.00																					1.66	50.00		125.00																		50.00				1.61	50.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.17	65.00		195.00																					2.17	65.00		162.50																		65.00				2.10	65.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	6	1	Generic	1	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	6	2	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		75.00																		30.00				.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	6	2	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		75.00																		30.00				.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.17	65.00		195.00																					2.17	65.00		162.50																		65.00				2.10	65.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	6	1	Generic	1	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	6	1	Generic	1	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	6	2	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		75.00																		30.00				.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.17	65.00		195.00																					2.17	65.00		162.50																		65.00				2.10	65.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.17	65.00		195.00																					2.17	65.00		162.50																		65.00				2.10	65.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	6	4	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	6	1	Generic	1	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	6	2	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.00	30.00		90.00																					1.00	30.00		75.00																		30.00				.97	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	8	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.40	12.00		36.00																					.40	12.00		30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.67	80.00		240.00																					2.67	80.00		200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	031	0	1	04	01	H7917_031_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	031	0	1	04	01	H7917_031_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	8	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.40	12.00		36.00																					.40	12.00		30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.67	80.00		240.00																					2.67	80.00		200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.40	12.00		36.00																					.40	12.00		30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	8	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.67	80.00		240.00																					2.67	80.00		200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	033	0	1	04	01	H7917_033_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.40	12.00		36.00																					.40	12.00		30.00																		12.00				.39	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	8	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.67	80.00		240.00																					2.67	80.00		200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7949	001	0	1	01	01	H7949_001_0	8	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7949	001	0	1	01	01	H7949_001_0	8	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					541.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7949	001	0	1	01	01	H7949_001_0	8	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7949	001	0	1	01	01	H7949_001_0	8	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.26	38.00		114.00																															104.00							114.00				38.00				1.22	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7949	001	0	1	01	01	H7949_001_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7949	001	0	1	01	01	H7949_001_0	8	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7949	001	0	1	01	01	H7949_001_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8016	001	0	1	48	05	H8016_001_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		10			1	30		90				1								29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8016	001	0	1	48	05	H8016_001_0	4	2	Brand Drugs	1	4	000010			110		10			1	30		90				1								29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H8016	001	0	1	48	05	H8016_001_0	4	1	Generic Drugs	1	4	010000			110		10			1	30		90				1								29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1											
H8046	001	0	1	48	05	H8046_001_0	6	5	Non-Medicare OTC Drugs	1	4	010010			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8046	001	0	1	48	05	H8046_001_0	6	4	Non-Medicare Rx Brand Drugs	1	4	000010			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8046	001	0	1	48	05	H8046_001_0	6	3	Non-Medicare Rx Generic Drugs	1	4	010000			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8046	001	0	1	48	05	H8046_001_0	6	2	Brand Drugs	1	4	000010			111		01	111		1	31	60	90				1	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1											
H8046	001	0	1	48	05	H8046_001_0	6	1	Generic Drugs	1	4	010000			111		01	111		1	31	60	90				1	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1											
H8064	002	0	1	04	01	H8064_002_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					913.26	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.23	7.00	14.00	21.00																					.23	7.00	14.00	21.00																		7.00				.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8064	002	0	1	04	01	H8064_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00	160.00	200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.33	40.00	80.00	120.00																					1.33	40.00	80.00	100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.83	25.00	50.00	75.00																					.83	25.00	50.00	62.50																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.23	7.00	14.00	21.00																					0.22	7.00	0.00	0.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	17	4	Non-Preferred Brand	1	4	110000	1	1	110		01	110		1	30		90				1	30		90				30		31					30.35	50		50																					50		50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	17	3	Preferred Brand	1	4	000001	1	1	110		01	110		1	30		90				1	30		90				30		31					50.97	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	17	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.50	15.00		37.50																					.50	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	17	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		3.00																					.10	3.00		3.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	17	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					511.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	18	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		3.00																					.10	3.00		3.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	18	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.50	15.00		37.50																					.50	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	18	3	Preferred Brand	1	4	000001	1	1	110		01	110		1	30		90				1	30		90				30		31					50.05	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	18	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					659.45	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	18	4	Non-Preferred Brand	1	4	110000	1	1	110		01	110		1	30		90				1	30		90				30		31					33.36	50		50																					50		50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	10	1	Generic	1	4	010000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	10	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	10	1	Generic	3	4	010000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8130	001	0	1	01	01	H8130_001_0	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31						25																							25																			25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	10	3	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	001	0	1	09	04	H8145_001_0	7	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	001	0	1	09	04	H8145_001_0	7	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	001	0	1	09	04	H8145_001_0	7	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	001	0	1	09	04	H8145_001_0	7	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	001	0	1	09	04	H8145_001_0	7	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.43	43.00		129.00																												1.43	43.00		119.00				1.43	43.00		129.00				43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	003	0	1	09	04	H8145_003_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	003	0	1	09	04	H8145_003_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	003	0	1	09	04	H8145_003_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	003	0	1	09	04	H8145_003_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	003	0	1	09	04	H8145_003_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	004	0	1	09	04	H8145_004_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	004	0	1	09	04	H8145_004_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	004	0	1	09	04	H8145_004_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	004	0	1	09	04	H8145_004_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	005	0	1	09	04	H8145_005_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	005	0	1	09	04	H8145_005_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	005	0	1	09	04	H8145_005_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	005	0	1	09	04	H8145_005_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	005	0	1	09	04	H8145_005_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	005	0	1	09	04	H8145_005_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	005	0	1	09	04	H8145_005_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	005	0	1	09	04	H8145_005_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	005	0	1	09	04	H8145_005_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	005	0	1	09	04	H8145_005_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	006	0	1	09	04	H8145_006_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	006	0	1	09	04	H8145_006_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	006	0	1	09	04	H8145_006_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	006	0	1	09	04	H8145_006_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	007	0	1	09	04	H8145_007_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	007	0	1	09	04	H8145_007_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	007	0	1	09	04	H8145_007_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	007	0	1	09	04	H8145_007_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	007	0	1	09	04	H8145_007_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	007	0	1	09	04	H8145_007_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	007	0	1	09	04	H8145_007_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	007	0	1	09	04	H8145_007_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	007	0	1	09	04	H8145_007_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	007	0	1	09	04	H8145_007_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	008	0	1	09	04	H8145_008_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	008	0	1	09	04	H8145_008_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	008	0	1	09	04	H8145_008_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	008	0	1	09	04	H8145_008_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	008	0	1	09	04	H8145_008_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	008	0	1	09	04	H8145_008_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	011	0	1	09	04	H8145_011_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	011	0	1	09	04	H8145_011_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	011	0	1	09	04	H8145_011_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	011	0	1	09	04	H8145_011_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	012	0	1	09	04	H8145_012_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	012	0	1	09	04	H8145_012_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	012	0	1	09	04	H8145_012_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	012	0	1	09	04	H8145_012_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	012	0	1	09	04	H8145_012_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	012	0	1	09	04	H8145_012_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	012	0	1	09	04	H8145_012_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	012	0	1	09	04	H8145_012_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	012	0	1	09	04	H8145_012_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	012	0	1	09	04	H8145_012_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	020	0	1	09	04	H8145_020_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	020	0	1	09	04	H8145_020_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	020	0	1	09	04	H8145_020_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	020	0	1	09	04	H8145_020_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	020	0	1	09	04	H8145_020_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	020	0	1	09	04	H8145_020_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	020	0	1	09	04	H8145_020_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	020	0	1	09	04	H8145_020_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	020	0	1	09	04	H8145_020_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	020	0	1	09	04	H8145_020_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	021	0	1	09	04	H8145_021_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	021	0	1	09	04	H8145_021_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	021	0	1	09	04	H8145_021_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	021	0	1	09	04	H8145_021_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	032	0	1	09	04	H8145_032_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	032	0	1	09	04	H8145_032_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	032	0	1	09	04	H8145_032_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	032	0	1	09	04	H8145_032_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	032	0	1	09	04	H8145_032_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	032	0	1	09	04	H8145_032_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	041	0	1	09	04	H8145_041_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	041	0	1	09	04	H8145_041_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	041	0	1	09	04	H8145_041_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	041	0	1	09	04	H8145_041_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	041	0	1	09	04	H8145_041_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	041	0	1	09	04	H8145_041_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	041	0	1	09	04	H8145_041_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	041	0	1	09	04	H8145_041_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	041	0	1	09	04	H8145_041_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	041	0	1	09	04	H8145_041_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	049	0	1	09	04	H8145_049_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	049	0	1	09	04	H8145_049_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	049	0	1	09	04	H8145_049_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	049	0	1	09	04	H8145_049_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	049	0	1	09	04	H8145_049_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	049	0	1	09	04	H8145_049_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	049	0	1	09	04	H8145_049_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	049	0	1	09	04	H8145_049_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	049	0	1	09	04	H8145_049_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	049	0	1	09	04	H8145_049_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	051	0	1	09	04	H8145_051_0	6	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	051	0	1	09	04	H8145_051_0	6	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	051	0	1	09	04	H8145_051_0	6	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.53	16.00		48.00																												0.53	16.00		0.00				0.53	16.00		48.00				16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	051	0	1	09	04	H8145_051_0	6	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	051	0	1	09	04	H8145_051_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	052	0	1	09	04	H8145_052_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	052	0	1	09	04	H8145_052_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	052	0	1	09	04	H8145_052_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	052	0	1	09	04	H8145_052_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	052	0	1	09	04	H8145_052_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	053	0	1	09	04	H8145_053_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	053	0	1	09	04	H8145_053_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	053	0	1	09	04	H8145_053_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	053	0	1	09	04	H8145_053_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	053	0	1	09	04	H8145_053_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	053	0	1	09	04	H8145_053_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	053	0	1	09	04	H8145_053_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	053	0	1	09	04	H8145_053_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	053	0	1	09	04	H8145_053_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	053	0	1	09	04	H8145_053_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	061	0	1	09	04	H8145_061_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	061	0	1	09	04	H8145_061_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	061	0	1	09	04	H8145_061_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	061	0	1	09	04	H8145_061_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	061	0	1	09	04	H8145_061_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	063	0	1	09	04	H8145_063_0	9	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	063	0	1	09	04	H8145_063_0	9	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	063	0	1	09	04	H8145_063_0	9	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	9	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	9	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	063	0	1	09	04	H8145_063_0	9	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	9	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	9	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	063	0	1	09	04	H8145_063_0	9	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	063	0	1	09	04	H8145_063_0	9	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	069	0	1	09	04	H8145_069_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	069	0	1	09	04	H8145_069_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	069	0	1	09	04	H8145_069_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	069	0	1	09	04	H8145_069_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	071	0	1	09	04	H8145_071_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	071	0	1	09	04	H8145_071_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	071	0	1	09	04	H8145_071_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	071	0	1	09	04	H8145_071_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	071	0	1	09	04	H8145_071_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	071	0	1	09	04	H8145_071_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	071	0	1	09	04	H8145_071_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	071	0	1	09	04	H8145_071_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	071	0	1	09	04	H8145_071_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	071	0	1	09	04	H8145_071_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	078	0	1	09	04	H8145_078_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	078	0	1	09	04	H8145_078_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	078	0	1	09	04	H8145_078_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	078	0	1	09	04	H8145_078_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	078	0	1	09	04	H8145_078_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	078	0	1	09	04	H8145_078_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	078	0	1	09	04	H8145_078_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	078	0	1	09	04	H8145_078_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	078	0	1	09	04	H8145_078_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	078	0	1	09	04	H8145_078_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	079	0	1	09	04	H8145_079_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	079	0	1	09	04	H8145_079_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	079	0	1	09	04	H8145_079_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	079	0	1	09	04	H8145_079_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	079	0	1	09	04	H8145_079_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	079	0	1	09	04	H8145_079_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	079	0	1	09	04	H8145_079_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	079	0	1	09	04	H8145_079_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	079	0	1	09	04	H8145_079_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	079	0	1	09	04	H8145_079_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	084	0	1	09	04	H8145_084_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	084	0	1	09	04	H8145_084_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	084	0	1	09	04	H8145_084_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	084	0	1	09	04	H8145_084_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	084	0	1	09	04	H8145_084_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	089	0	1	09	04	H8145_089_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	089	0	1	09	04	H8145_089_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	089	0	1	09	04	H8145_089_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	089	0	1	09	04	H8145_089_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	089	0	1	09	04	H8145_089_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	091	0	1	09	04	H8145_091_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	091	0	1	09	04	H8145_091_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	091	0	1	09	04	H8145_091_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	091	0	1	09	04	H8145_091_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	091	0	1	09	04	H8145_091_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	093	0	1	09	04	H8145_093_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	093	0	1	09	04	H8145_093_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	093	0	1	09	04	H8145_093_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	093	0	1	09	04	H8145_093_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	093	0	1	09	04	H8145_093_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	093	0	1	09	04	H8145_093_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	093	0	1	09	04	H8145_093_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	093	0	1	09	04	H8145_093_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	093	0	1	09	04	H8145_093_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	093	0	1	09	04	H8145_093_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	103	0	1	09	04	H8145_103_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	103	0	1	09	04	H8145_103_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	103	0	1	09	04	H8145_103_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	103	0	1	09	04	H8145_103_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	103	0	1	09	04	H8145_103_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	103	0	1	09	04	H8145_103_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	104	0	1	09	04	H8145_104_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	104	0	1	09	04	H8145_104_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	104	0	1	09	04	H8145_104_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	104	0	1	09	04	H8145_104_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	104	0	1	09	04	H8145_104_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	104	0	1	09	04	H8145_104_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	104	0	1	09	04	H8145_104_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	104	0	1	09	04	H8145_104_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	104	0	1	09	04	H8145_104_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	104	0	1	09	04	H8145_104_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	110	0	1	09	04	H8145_110_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	110	0	1	09	04	H8145_110_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	110	0	1	09	04	H8145_110_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	110	0	1	09	04	H8145_110_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	110	0	1	09	04	H8145_110_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	110	0	1	09	04	H8145_110_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	110	0	1	09	04	H8145_110_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	110	0	1	09	04	H8145_110_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	110	0	1	09	04	H8145_110_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	110	0	1	09	04	H8145_110_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	122	0	1	09	04	H8145_122_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	122	0	1	09	04	H8145_122_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	122	0	1	09	04	H8145_122_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	122	0	1	09	04	H8145_122_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	122	0	1	09	04	H8145_122_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	123	0	1	09	04	H8145_123_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	123	0	1	09	04	H8145_123_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	123	0	1	09	04	H8145_123_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.96	89.00		267.00																												2.96	89.00		257.00				2.96	89.00		267.00				89.00				2.87	89.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	123	0	1	09	04	H8145_123_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	123	0	1	09	04	H8145_123_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.96	89.00		267.00																												2.96	89.00		257.00				2.96	89.00		267.00				89.00				2.87	89.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	124	0	1	09	04	H8145_124_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	124	0	1	09	04	H8145_124_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.43	13.00		39.00																												0.43	13.00		0.00				0.43	13.00		39.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	124	0	1	09	04	H8145_124_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	124	0	1	09	04	H8145_124_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	124	0	1	09	04	H8145_124_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	124	0	1	09	04	H8145_124_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	124	0	1	09	04	H8145_124_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.43	13.00		39.00																												0.43	13.00		0.00				0.43	13.00		39.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	124	0	1	09	04	H8145_124_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	124	0	1	09	04	H8145_124_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	124	0	1	09	04	H8145_124_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	125	0	1	09	04	H8145_125_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	125	0	1	09	04	H8145_125_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	125	0	1	09	04	H8145_125_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	125	0	1	09	04	H8145_125_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	125	0	1	09	04	H8145_125_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	125	0	1	09	04	H8145_125_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	138	0	1	09	04	H8145_138_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	138	0	1	09	04	H8145_138_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	138	0	1	09	04	H8145_138_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	138	0	1	09	04	H8145_138_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	138	0	1	09	04	H8145_138_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	138	0	1	09	04	H8145_138_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	138	0	1	09	04	H8145_138_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	138	0	1	09	04	H8145_138_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	138	0	1	09	04	H8145_138_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	138	0	1	09	04	H8145_138_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	139	0	1	09	04	H8145_139_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	139	0	1	09	04	H8145_139_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	27																														27							27					27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	139	0	1	09	04	H8145_139_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	139	0	1	09	04	H8145_139_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	139	0	1	09	04	H8145_139_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	154	0	1	09	04	H8145_154_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	154	0	1	09	04	H8145_154_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	154	0	1	09	04	H8145_154_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	154	0	1	09	04	H8145_154_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	154	0	1	09	04	H8145_154_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	154	0	1	09	04	H8145_154_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8145	154	0	1	09	04	H8145_154_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	154	0	1	09	04	H8145_154_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	154	0	1	09	04	H8145_154_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	154	0	1	09	04	H8145_154_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	001	0	1	01	01	H8146_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	001	0	1	01	01	H8146_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					1.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	001	0	1	01	01	H8146_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.67	80.00		240.00																					2.67	80.00		200.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	001	0	1	01	01	H8146_001_0	6	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	001	0	1	01	01	H8146_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.33	10.00		30.00																					.33	10.00		25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	001	0	1	01	01	H8146_001_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		9.00																					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8189	001	0	1	01	01	H8189_001_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.45	45.00		45.00																								45.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H8189	001	0	1	01	01	H8189_001_0	6	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H8189	001	0	1	01	01	H8189_001_0	6	4	Injectable Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H8189	001	0	1	01	01	H8189_001_0	6	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	3.06	95.00		95.00																								95.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs												
H8237	001	0	1	01	01	H8237_001_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34						33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	2.50	75.00	150.00	225.00																					2.50	75.00	150.00	150.00																		75.00				2.21	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	1.33	40.00	80.00	120.00																					1.33	40.00	80.00	80.00																		40.00				1.18	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.50	15.00	30.00	45.00																					.50	15.00	30.00	30.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		34	.07	2.00	4.00	6.00																					.07	2.00	4.00	4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8258	001	0	1	48	05	H8258_001_0	8	5	Non-Medicare OTC Drugs	1	4	010010			010		10			1	30														10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8258	001	0	1	48	05	H8258_001_0	8	4	Non-Medicare Rx Brand Drugs	1	4	000010			010		10			1	30														10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8258	001	0	1	48	05	H8258_001_0	8	1	Generic Drugs	1	4	010000			110		10	100		1	30		90				1			90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1											
H8258	001	0	1	48	05	H8258_001_0	8	2	Brand Drugs	1	4	000010			110		10	100		1	30		90				1			90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1											
H8258	001	0	1	48	05	H8258_001_0	8	3	Non-Medicare Rx Generic Drugs	1	4	010000			010		10			1	30														10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8266	001	0	1	01	01	H8266_001_0	6	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	90				1	31	62	90				31		31	0.96	30.00	60.00	90.00																					0.80	25.00	50.00	75.00																		30.00				0.96	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	6	3	Non-Preferred Brand	1	4	100000	3	2	111		01	111		1	31	62	90				1	31	62	90				31		31	1.93	60.00	120.00	180.00																					1.45	45.00	90.00	135.00																		60.00				1.93	60.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	6	4	Specialty Tier	1	4	100000	1	1	111		01	111		1	31	62	90				1	31	62	90				31		31					100.00	33	33	33																					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	6	1	Generic	3	4	010000	1	2	111		01	111		1	31	62	90				1	31	62	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8266	001	0	1	01	01	H8266_001_0	6	1	Generic	1	4	010000	1	2	111		01	111		1	31	62	90				1	31	62	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8393	001	0	1	04	01	H8393_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.13	4.00	8.00	12.00					.30	9.00	18.00	27.00					.13	4.00	8.00	12.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8393	001	0	1	04	01	H8393_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.30	9.00	18.00	27.00					.40	12.00	24.00	36.00					.30	9.00	18.00	27.00																		12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8393	001	0	1	04	01	H8393_001_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8393	001	0	1	04	01	H8393_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00					3.06	92.00	184.00	276.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8393	001	0	1	04	01	H8393_001_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8432	001	0	1	01	01	H8432_001_0	7	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8432	001	0	1	01	01	H8432_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.35	80.00	160.00	240.00					2.50	85.00	170.00	255.00					2.35	80.00	240.00	240.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8432	001	0	1	01	01	H8432_001_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8432	001	0	1	01	01	H8432_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.29	10.00	20.00	30.00					.32	15.00	30.00	45.00					.29	10.00	20.00	20.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8432	001	0	1	01	01	H8432_001_0	7	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8432	001	0	1	01	01	H8432_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.12	4.00	8.00	12.00					.26	9.00	18.00	27.00					.12	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8452	001	0	1	48	05	H8452_001_0	4	5	Non-Medicare OTC Drugs	1	4	010010			010		01			1	30													30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8452	001	0	1	48	05	H8452_001_0	4	4	Non-Medicare Rx Brand Drugs	1	4	010010			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8452	001	0	1	48	05	H8452_001_0	4	3	Non-Medicare Rx Generic Drugs	1	4	010000			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8452	001	0	1	48	05	H8452_001_0	4	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8452	001	0	1	48	05	H8452_001_0	4	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8491	002	0	1	01	01	H8491_002_0	10	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.23	7.00	14.00	21.00																								17.50																		7.00				0.23	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8491	002	0	1	01	01	H8491_002_0	10	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8491	002	0	1	01	01	H8491_002_0	10	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								237.50																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8491	002	0	1	01	01	H8491_002_0	10	4	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31						25	25	25																							25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8552	001	0	1	04	01	H8552_001_0	7	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	001	0	1	04	01	H8552_001_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.50	85.00	170.00	255.00					2.65	90.00	180.00	270.00					2.50	85.00	255.00	255.00																		90.00				2.65	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	001	0	1	04	01	H8552_001_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	001	0	1	04	01	H8552_001_0	7	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.47	16.00	32.00	48.00					.62	21.00	42.00	63.00					.47	16.00	32.00	32.00																		21.00				.62	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	001	0	1	04	01	H8552_001_0	7	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					0.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	001	0	1	04	01	H8552_001_0	7	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	002	0	1	04	01	H8552_002_0	7	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					0.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	002	0	1	04	01	H8552_002_0	7	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.50	17.00	34.00	51.00					.65	22.00	44.00	66.00					.50	17.00	34.00	34.00																		22.00				.65	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	002	0	1	04	01	H8552_002_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	002	0	1	04	01	H8552_002_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	002	0	1	04	01	H8552_002_0	7	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													68.00	33	33	33					68.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	002	0	1	04	01	H8552_002_0	7	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	003	0	1	04	01	H8552_003_0	8	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													88.00	33	33	33					88.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	003	0	1	04	01	H8552_003_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.91	65.00	130.00	195.00					2.06	70.00	140.00	210.00					1.91	65.00	195.00	195.00																		70.00				2.06	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	003	0	1	04	01	H8552_003_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.88	30.00	60.00	90.00					1.03	35.00	70.00	105.00					.88	30.00	90.00	90.00																		35.00				1.03	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	003	0	1	04	01	H8552_003_0	8	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.50	17.00	34.00	51.00					.65	22.00	44.00	66.00					.50	17.00	34.00	34.00																		22.00				.65	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	003	0	1	04	01	H8552_003_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					0.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	003	0	1	04	01	H8552_003_0	8	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	006	0	1	04	01	H8552_006_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.47	16.00	32.00	48.00					.62	21.00	42.00	63.00					.47	16.00	32.00	32.00																		21.00				.62	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	006	0	1	04	01	H8552_006_0	6	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	006	0	1	04	01	H8552_006_0	6	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.06	36.00	72.00	108.00					1.21	41.00	82.00	123.00					1.06	36.00	108.00	108.00																		41.00				1.21	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	006	0	1	04	01	H8552_006_0	6	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.35	80.00	160.00	240.00					2.50	85.00	170.00	255.00					2.35	80.00	240.00	240.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	006	0	1	04	01	H8552_006_0	6	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	006	0	1	04	01	H8552_006_0	6	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	007	0	1	04	01	H8552_007_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.44	15.00	30.00	45.00					.59	20.00	40.00	60.00					.44	15.00	30.00	30.00																		20.00				.59	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	007	0	1	04	01	H8552_007_0	6	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	007	0	1	04	01	H8552_007_0	6	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	007	0	1	04	01	H8552_007_0	6	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	007	0	1	04	01	H8552_007_0	6	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	007	0	1	04	01	H8552_007_0	6	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.35	80.00	160.00	240.00					2.50	85.00	170.00	255.00					2.35	80.00	240.00	240.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	008	0	1	04	01	H8552_008_0	7	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.12	4.00	8.00	12.00					.26	9.00	18.00	27.00					.12	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	008	0	1	04	01	H8552_008_0	7	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.53	18.00	36.00	54.00					.68	23.00	46.00	69.00					.53	18.00	36.00	36.00																		23.00				.68	23.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	008	0	1	04	01	H8552_008_0	7	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													68.00	33	33	33					68.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	008	0	1	04	01	H8552_008_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.35	80.00	160.00	240.00					2.50	85.00	170.00	255.00					2.35	80.00	240.00	240.00																		85.00				2.50	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	008	0	1	04	01	H8552_008_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.09	37.00	74.00	111.00					1.24	42.00	84.00	126.00					1.09	37.00	111.00	111.00																		42.00				1.24	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	008	0	1	04	01	H8552_008_0	7	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	009	0	1	04	01	H8552_009_0	7	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													68.00	33	33	33					68.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	009	0	1	04	01	H8552_009_0	7	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	009	0	1	04	01	H8552_009_0	7	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					0.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	009	0	1	04	01	H8552_009_0	7	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.47	16.00	32.00	48.00					.62	21.00	42.00	63.00					.47	16.00	32.00	32.00																		21.00				.62	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	009	0	1	04	01	H8552_009_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.15	39.00	78.00	117.00					1.29	44.00	88.00	132.00					1.15	39.00	117.00	117.00																		44.00				1.29	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	009	0	1	04	01	H8552_009_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.38	81.00	162.00	243.00					2.53	86.00	172.00	258.00					2.38	81.00	243.00	243.00																		86.00				2.53	86.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	015	0	1	04	01	H8552_015_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.53	18.00	36.00	54.00					.68	23.00	46.00	69.00					.53	18.00	36.00	36.00																		23.00				.68	23.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	015	0	1	04	01	H8552_015_0	6	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					0.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	015	0	1	04	01	H8552_015_0	6	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	015	0	1	04	01	H8552_015_0	6	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	015	0	1	04	01	H8552_015_0	6	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	015	0	1	04	01	H8552_015_0	6	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	017	0	1	04	01	H8552_017_0	6	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.53	18.00	36.00	54.00					.68	23.00	46.00	69.00					.53	18.00	36.00	36.00																		23.00				.68	23.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	017	0	1	04	01	H8552_017_0	6	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					0.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	017	0	1	04	01	H8552_017_0	6	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.06	36.00	72.00	108.00					1.21	41.00	82.00	123.00					1.06	36.00	108.00	108.00																		41.00				1.21	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	017	0	1	04	01	H8552_017_0	6	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	017	0	1	04	01	H8552_017_0	6	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	017	0	1	04	01	H8552_017_0	6	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.53	86.00	172.00	258.00					2.68	91.00	182.00	273.00					2.53	86.00	258.00	258.00																		91.00				2.68	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	018	0	1	04	01	H8552_018_0	7	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					0.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	018	0	1	04	01	H8552_018_0	7	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.50	17.00	34.00	51.00					.65	22.00	44.00	66.00					.50	17.00	34.00	34.00																		22.00				.65	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	018	0	1	04	01	H8552_018_0	7	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.79	95.00	190.00	285.00					2.79	95.00	190.00	285.00					2.79	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	018	0	1	04	01	H8552_018_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.06	70.00	140.00	210.00					2.21	75.00	150.00	225.00					2.06	70.00	210.00	210.00																		75.00				2.21	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	018	0	1	04	01	H8552_018_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8552	018	0	1	04	01	H8552_018_0	7	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	7	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31						33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	8	2	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	1.33	40.00	80.00	120.00																								80.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	8	3	Non-Preferred Brand	1	4	100000	3	2	111		01	100		1	30	60	90				1			90				30		31	2.50	75.00	150.00	225.00																								225.00																		75.00				2.42	75.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	8	1	Generic	1	4	010000	3	2	111		01	100		1	30	60	90				1			90				30		31	.33	10.00	20.00	30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	8	4	Specialty Tier	1	4	110001	3	1	010		01			1	30													30		31					1.00	33																																										33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	8	1	Generic	3	4	010000	3	2	111		01	100		1	30	60	90				1			90				30		31	.33	10.00	20.00	30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8578	004	0	1	01	01	H8578_004_0	8	1	Generic	1	4	010000	3	2	111		01	100		1	30	60	90				1			90				30		31	.33	10.00	20.00	30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	8	2	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	1.33	40.00	80.00	120.00																								80.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	8	3	Non-Preferred Brand	1	4	100000	3	2	111		01	100		1	30	60	90				1			90				30		31	2.50	75.00	150.00	225.00																								225.00																		75.00				2.41	75.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	8	4	Specialty Tier	1	4	110001	3	1	010		01	010		1	30							30						30		31					1.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	8	1	Generic	3	4	010000	3	2	111		01	100		1	30	60	90				1			90				30		31	.32	10.00	20.00	30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8578	007	0	1	01	01	H8578_007_0	8	1	Generic	1	4	010000	3	2	111		01	100		1	30	60	90				1			90				30		31	.33	10.00	20.00	30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	007	0	1	01	01	H8578_007_0	8	2	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	1.33	40.00	80.00	120.00																								80.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	007	0	1	01	01	H8578_007_0	8	1	Generic	3	4	010000	3	2	111		01	100		1	30	60	90				1			90				30		31	.32	10.00	20.00	30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8578	007	0	1	01	01	H8578_007_0	8	4	Specialty Tier	1	4	110001	3	1	010		01	010		1	30							30						30		31					1.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	007	0	1	01	01	H8578_007_0	8	3	Non-Preferred Brand	1	4	100000	3	2	111		01	100		1	30	60	90				1			90				30		31	2.50	75.00	150.00	225.00																								225.00																		75.00				2.41	75.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	010	0	1	02	01	H8578_010_0	9	1	Generic	3	4	010000	3	2	111		01	100		1	30	60	90				1			90				30		31	.32	10.00	20.00	30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8578	010	0	1	02	01	H8578_010_0	9	3	Non-Preferred Brand	1	4	100000	3	2	111		01	100		1	30	60	90				1			90				30		31	2.50	75.00	150.00	225.00																								225.00																		75.00				2.41	75.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	010	0	1	02	01	H8578_010_0	9	2	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	1.33	40.00	80.00	120.00																								80.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	010	0	1	02	01	H8578_010_0	9	4	Specialty Tier	1	4	110001	3	1	010		01	010		1	30							30						30		31					1.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	010	0	1	02	01	H8578_010_0	9	1	Generic	1	4	010000	3	2	111		01	100		1	30	60	90				1			90				30		31	.33	10.00	20.00	30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	8	2	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								90.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	8	4	Specialty Tier	1	4	110001	3	1	010		01			1	30													30		31					1.00	30																																										30				30	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	8	3	Non-Preferred Brand	1	4	100000	3	2	111		01	100		1	30	60	90				1			90				30		31	3.00	90.00	180.00	270.00																								270.00																		90.00				2.90	90.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	8	1	Generic	1	4	010000	3	2	111		01	100		1	30	60	90				1			90				30		31	.33	10.00	20.00	30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	001	0	1	04	01	H8604_001_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.50	15.00		45.00																								30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	001	0	1	04	01	H8604_001_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.27	8.00		24.00																								16.00																		8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	001	0	1	04	01	H8604_001_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	001	0	1	04	01	H8604_001_0	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1000.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	001	0	1	04	01	H8604_001_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.27	8.00		24.00																								16.00																		8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H8604	001	0	1	04	01	H8604_001_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.50	15.00		45.00																								30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H8604	003	0	1	04	01	H8604_003_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.67	20.00		60.00																								40.00																		20.00				0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	003	0	1	04	01	H8604_003_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	003	0	1	04	01	H8604_003_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	003	0	1	04	01	H8604_003_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H8604	003	0	1	04	01	H8604_003_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	005	0	1	04	01	H8604_005_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	005	0	1	04	01	H8604_005_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	005	0	1	04	01	H8604_005_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	005	0	1	04	01	H8604_005_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H8604	005	0	1	04	01	H8604_005_0	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	005	0	1	04	01	H8604_005_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H8604	006	0	1	04	01	H8604_006_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	006	0	1	04	01	H8604_006_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H8604	006	0	1	04	01	H8604_006_0	8	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
H8604	006	0	1	04	01	H8604_006_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	006	0	1	04	01	H8604_006_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8604	006	0	1	04	01	H8604_006_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	13	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	13	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	13	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	13	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	13	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	12	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	12	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	12	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8644	003	0	1	04	01	H8644_003_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8644	003	0	1	04	01	H8644_003_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8644	003	0	1	04	01	H8644_003_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8644	003	0	1	04	01	H8644_003_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8644	003	0	1	04	01	H8644_003_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8644	003	0	1	04	01	H8644_003_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8644	003	0	1	04	01	H8644_003_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8644	003	0	1	04	01	H8644_003_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8644	003	0	1	04	01	H8644_003_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8644	003	0	1	04	01	H8644_003_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8644	005	0	1	04	01	H8644_005_0	4	5	Specialty Tier	3	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8644	005	0	1	04	01	H8644_005_0	4	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.00	90.00		270.00					3.16	95.00		285.00												3.00	90.00		260.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8644	005	0	1	04	01	H8644_005_0	4	3	Preferred Brand	3	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	15		15					38.00	25		25												15		15					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8644	005	0	1	04	01	H8644_005_0	4	2	Non-Preferred Generic	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.36	11.00		33.00												0.10	3.00		0.00				0.36	11.00		33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8644	005	0	1	04	01	H8644_005_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8644	005	0	1	04	01	H8644_005_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.10	3.00		9.00					0.36	11.00		33.00												0.10	3.00		0.00				0.36	11.00		33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8644	005	0	1	04	01	H8644_005_0	4	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													16.00	15		15					28.00	25		25												15		15					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8644	005	0	1	04	01	H8644_005_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													35.00	30		30					63.00	50		50												30		30					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8644	005	0	1	04	01	H8644_005_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.26	8.00		24.00												0.03	1.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	003	0	1	02	01	H8649_003_0	17	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	003	0	1	02	01	H8649_003_0	17	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									3.06	92.00	184.00	275.00					3.16	95.00	190.00	275.00					3.06	92.00	184.00	275.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	003	0	1	02	01	H8649_003_0	17	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	8.00					0.26	8.00	16.00	16.00					0.13	4.00	8.00	0.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	003	0	1	02	01	H8649_003_0	17	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.23	7.00	14.00	14.00					0.33	10.00	20.00	20.00					0.23	7.00	14.00	14.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	003	0	1	02	01	H8649_003_0	17	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	125.00					1.50	45.00	90.00	125.00					1.40	42.00	84.00	125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8677	001	0	1	48	05	H8677_001_0	7	1	Generic Drugs	1	4	010000			111		01	111		1	31	60	90				1	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1											
H8677	001	0	1	48	05	H8677_001_0	7	2	Brand Drugs	1	4	000010			111		01	111		1	31	60	90				1	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1											
H8677	001	0	1	48	05	H8677_001_0	7	3	Non-Medicare Rx Generic Drugs	1	4	010000			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	001	0	1	48	05	H8677_001_0	7	4	Non-Medicare Rx Brand Drugs	1	4	000010			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	001	0	1	48	05	H8677_001_0	7	5	Non-Medicare OTC Drugs	1	4	010010			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_0	1	5	Non-Medicare OTC Drugs	1	4	010010			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_0	1	4	Non-Medicare Rx Brand Drugs	1	4	000010			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_0	1	3	Non-Medicare Rx Generic Drugs	1	4	010000			010		01	010		1	31							31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_0	1	2	Brand Drugs	1	4	000010			111		01	111		1	31	60	90				1	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1											
H8677	002	0	1	48	05	H8677_002_0	1	1	Generic Drugs	1	4	010000			111		01	111		1	31	60	90				1	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs	1											
H8684	001	0	1	04	01	H8684_001_0	5	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8684	001	0	1	04	01	H8684_001_0	5	3	Non-Preferred Brand	1	4	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	190.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8684	001	0	1	04	01	H8684_001_0	5	2	Preferred Brand	1	4	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	90.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8684	001	0	1	04	01	H8684_001_0	5	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.26	8.00	16.00	24.00																												.26	8.00	16.00	16.00				.26	8.00	16.00	24.00					8.00			.25	8.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8684	001	0	1	04	01	H8684_001_0	5	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.26	8.00	16.00	24.00					8.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H8684	001	0	1	04	01	H8684_001_0	5	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	0.00	0.00	0.00	0.00																												0.00	0.00	0.00	0.00				.26	8.00	16.00	24.00					8.00			0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8707	001	0	1	04	01	H8707_001_0	7	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8707	001	0	1	04	01	H8707_001_0	7	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8707	001	0	1	04	01	H8707_001_0	7	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8707	001	0	1	04	01	H8707_001_0	7	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8707	001	0	1	04	01	H8707_001_0	7	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8707	001	0	1	04	01	H8707_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8707	001	0	1	04	01	H8707_001_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8707	001	0	1	04	01	H8707_001_0	7	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8707	001	0	1	04	01	H8707_001_0	7	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8707	001	0	1	04	01	H8707_001_0	7	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8707	003	0	1	04	01	H8707_003_0	6	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8707	003	0	1	04	01	H8707_003_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8707	003	0	1	04	01	H8707_003_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8707	003	0	1	04	01	H8707_003_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8707	003	0	1	04	01	H8707_003_0	6	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8707	003	0	1	04	01	H8707_003_0	6	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8707	003	0	1	04	01	H8707_003_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8707	003	0	1	04	01	H8707_003_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8707	003	0	1	04	01	H8707_003_0	6	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8707	003	0	1	04	01	H8707_003_0	6	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8748	002	0	1	01	01	H8748_002_0	4	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8748	002	0	1	01	01	H8748_002_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					580.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8748	002	0	1	01	01	H8748_002_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8748	002	0	1	01	01	H8748_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8748	002	0	1	01	01	H8748_002_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	5	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				1			90				30		31						33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	5	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.83	85.00		255.00																								255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	5	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	5	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.66	20.00		60.00																								60.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	5	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	01	01	H8764_002_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	01	01	H8764_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.40	12.00		36.00																								36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	01	01	H8764_002_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	01	01	H8764_002_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.50	75.00		225.00																								225.00																		75.00				2.41	75.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	01	01	H8764_002_0	4	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31						33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8822	004	0	1	01	01	H8822_004_0	13	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8822	004	0	1	01	01	H8822_004_0	13	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8822	004	0	1	01	01	H8822_004_0	13	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.45	45.00		135.00																					1.45	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8822	004	0	1	01	01	H8822_004_0	13	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	2.90	90.00		270.00																					2.90	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8822	004	0	1	01	01	H8822_004_0	13	5	Specialty Tier	1	4	000010	1	1	110		01	110		1	30		90				2	30		90				30		31					33.00	33		33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8822	004	0	1	01	01	H8822_004_0	13	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8822	004	0	1	01	01	H8822_004_0	13	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.32	10.00		30.00																					.32	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8870	001	0	1	01	01	H8870_001_0	10	1	Generic	1	4	010000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8870	001	0	1	01	01	H8870_001_0	10	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	135.00																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8870	001	0	1	01	01	H8870_001_0	10	3	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8870	001	0	1	01	01	H8870_001_0	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31						25																							25																			25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8908	001	0	1	01	01	H8908_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8908	001	0	1	01	01	H8908_001_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8908	001	0	1	01	01	H8908_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8908	001	0	1	01	01	H8908_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8908	001	0	1	01	01	H8908_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	001	0	1	01	01	H8953_001_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	001	0	1	01	01	H8953_001_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	001	0	1	01	01	H8953_001_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	001	0	1	01	01	H8953_001_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	001	0	1	01	01	H8953_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	001	0	1	01	01	H8953_001_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	001	0	1	01	01	H8953_001_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	001	0	1	01	01	H8953_001_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8953	001	0	1	01	01	H8953_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	001	0	1	01	01	H8953_001_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	002	0	1	01	01	H8953_002_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	002	0	1	01	01	H8953_002_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	002	0	1	01	01	H8953_002_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	002	0	1	01	01	H8953_002_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	002	0	1	01	01	H8953_002_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8953	002	0	1	01	01	H8953_002_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	002	0	1	01	01	H8953_002_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	002	0	1	01	01	H8953_002_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	002	0	1	01	01	H8953_002_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	002	0	1	01	01	H8953_002_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	003	0	1	01	01	H8953_003_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	003	0	1	01	01	H8953_003_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	003	0	1	01	01	H8953_003_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	003	0	1	01	01	H8953_003_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	003	0	1	01	01	H8953_003_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	003	0	1	01	01	H8953_003_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	003	0	1	01	01	H8953_003_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	003	0	1	01	01	H8953_003_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	003	0	1	01	01	H8953_003_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8953	003	0	1	01	01	H8953_003_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	005	0	1	01	01	H8953_005_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	005	0	1	01	01	H8953_005_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	005	0	1	01	01	H8953_005_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	005	0	1	01	01	H8953_005_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	005	0	1	01	01	H8953_005_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	005	0	1	01	01	H8953_005_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	005	0	1	01	01	H8953_005_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	005	0	1	01	01	H8953_005_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	005	0	1	01	01	H8953_005_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8953	005	0	1	01	01	H8953_005_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	006	0	1	01	01	H8953_006_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	006	0	1	01	01	H8953_006_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	006	0	1	01	01	H8953_006_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	006	0	1	01	01	H8953_006_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	006	0	1	01	01	H8953_006_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	006	0	1	01	01	H8953_006_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	006	0	1	01	01	H8953_006_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	006	0	1	01	01	H8953_006_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8953	006	0	1	01	01	H8953_006_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	006	0	1	01	01	H8953_006_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	007	0	1	01	01	H8953_007_0	6	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	007	0	1	01	01	H8953_007_0	6	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	007	0	1	01	01	H8953_007_0	6	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	007	0	1	01	01	H8953_007_0	6	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	007	0	1	01	01	H8953_007_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	008	0	1	01	01	H8953_008_0	8	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	008	0	1	01	01	H8953_008_0	8	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.33	10.00		30.00																												0.33	10.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	008	0	1	01	01	H8953_008_0	8	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	008	0	1	01	01	H8953_008_0	8	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	008	0	1	01	01	H8953_008_0	8	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	009	0	1	01	01	H8953_009_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	009	0	1	01	01	H8953_009_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	009	0	1	01	01	H8953_009_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	009	0	1	01	01	H8953_009_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	009	0	1	01	01	H8953_009_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	009	0	1	01	01	H8953_009_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8953	009	0	1	01	01	H8953_009_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	009	0	1	01	01	H8953_009_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	009	0	1	01	01	H8953_009_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	009	0	1	01	01	H8953_009_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	010	0	1	01	01	H8953_010_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8953	010	0	1	01	01	H8953_010_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	010	0	1	01	01	H8953_010_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	010	0	1	01	01	H8953_010_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	010	0	1	01	01	H8953_010_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	010	0	1	01	01	H8953_010_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	010	0	1	01	01	H8953_010_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	010	0	1	01	01	H8953_010_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	010	0	1	01	01	H8953_010_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	010	0	1	01	01	H8953_010_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	011	0	1	01	01	H8953_011_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	011	0	1	01	01	H8953_011_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	011	0	1	01	01	H8953_011_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	011	0	1	01	01	H8953_011_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	011	0	1	01	01	H8953_011_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	011	0	1	01	01	H8953_011_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	011	0	1	01	01	H8953_011_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8953	011	0	1	01	01	H8953_011_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	011	0	1	01	01	H8953_011_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	011	0	1	01	01	H8953_011_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	012	0	1	01	01	H8953_012_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	012	0	1	01	01	H8953_012_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	012	0	1	01	01	H8953_012_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	012	0	1	01	01	H8953_012_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	012	0	1	01	01	H8953_012_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H8953	012	0	1	01	01	H8953_012_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	012	0	1	01	01	H8953_012_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	012	0	1	01	01	H8953_012_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	012	0	1	01	01	H8953_012_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	012	0	1	01	01	H8953_012_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	014	0	1	01	01	H8953_014_0	7	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	014	0	1	01	01	H8953_014_0	7	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.30	9.00		27.00																												0.30	9.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	014	0	1	01	01	H8953_014_0	7	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00	0.00		0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	014	0	1	01	01	H8953_014_0	7	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	014	0	1	01	01	H8953_014_0	7	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	31																														31							31					31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	002	0	1	04	01	H8980_002_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.30	9.00	18.00	27.00					0.13	4.00	8.00	10.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	002	0	1	04	01	H8980_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.56	17.00	34.00	51.00					1.10	33.00	66.00	99.00					0.56	17.00	34.00	42.50																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	002	0	1	04	01	H8980_002_0	9	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	002	0	1	04	01	H8980_002_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	002	0	1	04	01	H8980_002_0	9	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.36	41.00	82.00	123.00					1.50	45.00	90.00	135.00					1.36	41.00	82.00	102.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	004	0	1	04	01	H8980_004_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	004	0	1	04	01	H8980_004_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	004	0	1	04	01	H8980_004_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.33	10.00	20.00	30.00					0.13	4.00	8.00	10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8980	004	0	1	04	01	H8980_004_0	4	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	105.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	004	0	1	04	01	H8980_004_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.10	33.00	66.00	99.00					0.66	20.00	40.00	50.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	004	0	1	04	01	H8980_004_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.13	4.00	8.00	12.00					0.33	10.00	20.00	30.00					0.13	4.00	8.00	10.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	005	0	1	04	01	H8980_005_0	10	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	005	0	1	04	01	H8980_005_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	005	0	1	04	01	H8980_005_0	10	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.10	33.00	66.00	99.00					0.66	20.00	40.00	50.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	005	0	1	04	01	H8980_005_0	10	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8980	005	0	1	04	01	H8980_005_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	005	0	1	04	01	H8980_005_0	10	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	006	0	1	04	01	H8980_006_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00					1.16	35.00	70.00	87.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	006	0	1	04	01	H8980_006_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	006	0	1	04	01	H8980_006_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.66	20.00	40.00	60.00					1.10	33.00	66.00	99.00					0.66	20.00	40.00	50.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	006	0	1	04	01	H8980_006_0	7	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	12.50																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8980	006	0	1	04	01	H8980_006_0	7	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8980	006	0	1	04	01	H8980_006_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	017	0	1	01	01	H8991_017_0	5	2	Non-Preferred Generic	1	4	000100	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					1.21	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	017	0	1	01	01	H8991_017_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	017	0	1	01	01	H8991_017_0	5	3	Preferred Brand	1	4	000001	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.57	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	017	0	1	01	01	H8991_017_0	5	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	017	0	1	01	01	H8991_017_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	017	0	1	01	01	H8991_017_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8991	028	0	1	01	01	H8991_028_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.32	10.00	20.00	30.00																					.32	10.00	15.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	028	0	1	01	01	H8991_028_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.12	4.00	8.00	12.00																					.13	4.00	6.00	8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	028	0	1	01	01	H8991_028_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	67.50	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	028	0	1	01	01	H8991_028_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31						33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	028	0	1	01	01	H8991_028_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	142.50	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	029	0	1	01	01	H8991_029_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	029	0	1	01	01	H8991_029_0	7	2	Non-Preferred Generic	1	4	000100	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					1.21	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	029	0	1	01	01	H8991_029_0	7	3	Preferred Brand	1	4	000001	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.57	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	029	0	1	01	01	H8991_029_0	7	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	029	0	1	01	01	H8991_029_0	7	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					3.60	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8991	029	0	1	01	01	H8991_029_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9001	013	0	1	02	01	H9001_013_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	013	0	1	02	01	H9001_013_0	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	013	0	1	02	01	H9001_013_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.87	27.00	54.00	81.00																					0.87	27.00	54.00	81.00																		27.00				0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	013	0	1	02	01	H9001_013_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	013	0	1	02	01	H9001_013_0	7	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					801.65	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	9	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	9	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					789.28	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.87	27.00	54.00	81.00																					0.87	27.00	54.00	81.00																		27.00				0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	019	0	1	01	01	H9001_019_0	8	1	Preferred Generic	1	4	001000	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31						25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H9001	019	0	1	01	01	H9001_019_0	8	2	Preferred Brand	1	4	000101	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31						25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H9001	019	0	1	01	01	H9001_019_0	8	3	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31						25	25	25																					25	25	25																	25				25	Preferred Generic, Preferred Brand, Non-Preferred Brand												
H9001	030	1	1	01	01	H9001_030_1	7	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					1170.30	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.87	27.00	54.00	81.00																					0.87	27.00	54.00	81.00																		27.00				0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	8	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					1170.30	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.87	27.00	54.00	81.00																					0.87	27.00	54.00	81.00																		27.00				0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.87	27.00	54.00	81.00																					0.87	27.00	54.00	81.00																		27.00				0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	8	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					1170.30	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	8	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					1170.30	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.87	27.00	54.00	81.00																					0.87	27.00	54.00	81.00																		27.00				0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.87	27.00	54.00	81.00																					0.87	27.00	54.00	81.00																		27.00				0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	7	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					761.44	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.87	27.00	54.00	81.00																					0.87	27.00	54.00	81.00																		27.00				0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	7	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					761.44	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.87	27.00	54.00	81.00																					0.87	27.00	54.00	81.00																		27.00				0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	7	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					761.44	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	5	1	01	01	H9001_031_5	7	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					761.44	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	5	1	01	01	H9001_031_5	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	5	1	01	01	H9001_031_5	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	5	1	01	01	H9001_031_5	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	5	1	01	01	H9001_031_5	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.87	27.00	54.00	81.00																					0.87	27.00	54.00	81.00																		27.00				0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.87	27.00	54.00	81.00																					0.87	27.00	54.00	81.00																		27.00				0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	7	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					761.44	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	7	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					601.46	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.06	32.00	64.00	96.00																					1.06	32.00	64.00	96.00																		32.00				1.03	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.06	32.00	64.00	96.00																					1.06	32.00	64.00	96.00																		32.00				1.03	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	7	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					601.46	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.06	32.00	64.00	96.00																					1.06	32.00	64.00	96.00																		32.00				1.03	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	8	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					601.46	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	8	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.06	32.00	64.00	96.00																					1.06	32.00	64.00	96.00																		32.00				1.03	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	7	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					601.46	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	7	5	Specialty Tier	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					601.46	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	1.06	32.00	64.00	96.00																					1.06	32.00	64.00	96.00																		32.00				1.03	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	7	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9003	001	0	1	01	01	H9003_001_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	001	0	1	01	01	H9003_001_0	10	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	001	0	1	01	01	H9003_001_0	10	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.33	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	001	0	1	01	01	H9003_001_0	10	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					556.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	4	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.33	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	01	01	H9003_006_0	4	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	01	01	H9003_006_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	01	01	H9003_006_0	4	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00	0.00																																												0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	4	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31					707.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9011	019	0	1	02	01	H9011_019_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9011	019	0	1	02	01	H9011_019_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9011	019	0	1	02	01	H9011_019_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9011	019	0	1	02	01	H9011_019_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9011	019	0	1	02	01	H9011_019_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00	0.00		0.00																															0.00							0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9011	019	0	1	02	01	H9011_019_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					490.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9011	020	0	1	01	01	H9011_020_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					551.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9011	020	0	1	01	01	H9011_020_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9011	020	0	1	01	01	H9011_020_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9011	020	0	1	01	01	H9011_020_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.23	7.00		21.00																															14.00							21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9011	020	0	1	01	01	H9011_020_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.10	3.00		9.00																															6.00							9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	10	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													0.00	33							0.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	10	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34													48.38	33							48.38	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	10	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	10	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	10	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.36	11.00	22.00	33.00					0.66	20.00	40.00	60.00												0.36	11.00	22.00	33.00				0.66	20.00	40.00	60.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	10	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.20	6.00	12.00	18.00					0.30	9.00	18.00	27.00												0.20	6.00	12.00	18.00				0.30	9.00	18.00	27.00				9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	10	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													0.00	33							0.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	10	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34													48.38	33							48.38	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	10	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	10	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	10	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.36	11.00	22.00	33.00					0.66	20.00	40.00	60.00												0.36	11.00	22.00	33.00				0.66	20.00	40.00	60.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	10	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.20	6.00	12.00	18.00					0.30	9.00	18.00	27.00												0.20	6.00	12.00	18.00				0.30	9.00	18.00	27.00				9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	10	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.20	6.00	12.00	18.00					0.30	9.00	18.00	27.00												0.20	6.00	12.00	18.00				0.30	9.00	18.00	27.00				9.00				0.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	10	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34													48.38	33							48.38	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	10	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34													0.00	33							0.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	10	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00				45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	10	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00				95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	10	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34									0.36	11.00	22.00	33.00					0.66	20.00	40.00	60.00												0.36	11.00	22.00	33.00				0.66	20.00	40.00	60.00				20.00				0.58	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9082	002	0	1	01	01	H9082_002_0	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31						33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9082	002	0	1	01	01	H9082_002_0	10	3	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.93	60.00	120.00	180.00																					1.93	60.00	120.00	180.00																		60.00				1.93	60.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9082	002	0	1	01	01	H9082_002_0	10	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.96	30.00	60.00	90.00																					.96	30.00	60.00	90.00																		30.00				.96	30.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9082	002	0	1	01	01	H9082_002_0	10	1	Generic	1	4	010000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.16	5.00	10.00	15.00																					.16	5.00	10.00	15.00																		5.00				.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9104	006	0	1	01	01	H9104_006_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.25	39.00	78.00	117.00																					1.25	39.00	78.00	78.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.74	85.00	170.00	255.00																					2.74	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					399.92	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	4	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.09	3.00	6.00	9.00																					0.09	3.00	6.00	6.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9104	006	0	1	01	01	H9104_006_0	4	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9110	002	0	1	01	01	H9110_002_0	8	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	0.66	20.00		60.00																					0.66	20.00		40.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9110	002	0	1	01	01	H9110_002_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9110	002	0	1	01	01	H9110_002_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9110	002	0	1	01	01	H9110_002_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					453.00	27																							27																			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9110	002	0	1	01	01	H9110_002_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9122	001	0	1	01	01	H9122_001_0	6	3	Preferred Brand	1	4	000001	1	2	110		01			1	30		90				1							30		31	1.33	40.00		120.00																																										40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9122	001	0	1	01	01	H9122_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01			1	30		90				1							30		31	.27	8.00		24.00																																										8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9122	001	0	1	01	01	H9122_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01			1	30		90				1							30		31	.06	2.00		6.00																																										2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9122	001	0	1	01	01	H9122_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01			1	30		90				2							30		31						33		33																																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9122	001	0	1	01	01	H9122_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01			1	30		90				1							30		31	3.00	90.00		270.00																																										90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	003	0	1	01	01	H9190_003_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	003	0	1	01	01	H9190_003_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	003	0	1	01	01	H9190_003_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	003	0	1	01	01	H9190_003_0	4	6	Select Care Drugs	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	003	0	1	01	01	H9190_003_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31					1.00	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	003	0	1	01	01	H9190_003_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	004	0	1	01	01	H9190_004_0	4	6	Select Care Drugs	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	004	0	1	01	01	H9190_004_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31					1.00	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	004	0	1	01	01	H9190_004_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	004	0	1	01	01	H9190_004_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	004	0	1	01	01	H9190_004_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.33	10.00	20.00	30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	004	0	1	01	01	H9190_004_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	005	0	1	01	01	H9190_005_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31					1.00	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	005	0	1	01	01	H9190_005_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.13	4.00	8.00	12.00																								8.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	005	0	1	01	01	H9190_005_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.50	15.00	30.00	45.00																								30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	005	0	1	01	01	H9190_005_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	005	0	1	01	01	H9190_005_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	006	0	1	01	01	H9190_006_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31					1.00	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	006	0	1	01	01	H9190_006_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	006	0	1	01	01	H9190_006_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	0.50	15.00	30.00	45.00																								30.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	006	0	1	01	01	H9190_006_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	006	0	1	01	01	H9190_006_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.16	95.00	190.00	285.00																								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	002	0	1	01	01	H9207_002_0	6	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Generic, Brand, Specialty Tier												
H9207	002	0	1	01	01	H9207_002_0	6	2	Brand	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	90.00																								90.00																		45.00				1.45	45.00		Generic, Brand, Specialty Tier												
H9207	002	0	1	01	01	H9207_002_0	6	3	Specialty Tier	1	4	000010	1	1	111		01	100		1	30	60	90				1			90				30		31						33	33	33																							33																	33				33	Generic, Brand, Specialty Tier												
H9207	003	0	1	01	01	H9207_003_0	6	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Generic, Brand, Specialty Tier												
H9207	003	0	1	01	01	H9207_003_0	6	2	Brand	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	1.50	45.00	90.00	90.00																								90.00																		45.00				1.45	45.00		Generic, Brand, Specialty Tier												
H9207	003	0	1	01	01	H9207_003_0	6	3	Specialty Tier	1	4	000010	1	1	111		01	100		1	30	60	90				1			90				30		31						33	33	33																							33																	33				33	Generic, Brand, Specialty Tier												
H9264	001	0	1	48	05	H9264_001_0	5	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	2.55	0.00	2.55	0.00	2.55	0.00	2.55			
H9264	001	0	1	48	05	H9264_001_0	5	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	6.35	0.00	6.35	0.00	6.35	0.00	6.35			
H9264	001	0	1	48	05	H9264_001_0	5	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9285	001	0	1	01	01	H9285_001_0	6	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.30	39.00		117.00																					1.30	39.00		78.00																		39.00				1.25	39.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	001	0	1	01	01	H9285_001_0	6	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	001	0	1	01	01	H9285_001_0	6	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.63	79.00		237.00																					2.63	79.00		158.00																		79.00				2.54	79.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	001	0	1	01	01	H9285_001_0	6	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	002	0	1	01	01	H9285_002_0	6	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.16	35.00		105.00																					1.16	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	002	0	1	01	01	H9285_002_0	6	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	002	0	1	01	01	H9285_002_0	6	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.63	79.00		237.00																					2.63	79.00		158.00																		79.00				2.54	79.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	002	0	1	01	01	H9285_002_0	6	1	Preferred Generic	3	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9285	002	0	1	01	01	H9285_002_0	6	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	003	0	1	01	01	H9285_003_0	6	1	Preferred Generic	1	4	001010	3	2	110		01	110		1	30		90				1	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	003	0	1	01	01	H9285_003_0	6	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	2.63	79.00		237.00																					2.63	79.00		158.00																		79.00				2.54	79.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	003	0	1	01	01	H9285_003_0	6	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	1.16	35.00		105.00																					1.16	35.00		70.00																		35.00				1.12	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	003	0	1	01	01	H9285_003_0	6	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31						33		33																					33		33																	33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	001	0	1	01	01	H9302_001_0	11	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.19	6.00	12.00	15.00																					.19	6.00	12.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	001	0	1	01	01	H9302_001_0	11	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.16	36.00	72.00	90.00																					1.16	36.00	72.00	72.00																		36.00				1.16	36.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	001	0	1	01	01	H9302_001_0	11	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.58	18.00	36.00	45.00																					.58	18.00	36.00	36.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	001	0	1	01	01	H9302_001_0	11	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.94	60.00	120.00	150.00																					1.94	60.00	120.00	120.00																		60.00				1.94	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	001	0	1	01	01	H9302_001_0	11	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					698.34	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	001	0	1	01	01	H9302_001_0	11	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.19	6.00	12.00	18.00																					.19	6.00	12.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9302	001	0	1	01	01	H9302_001_0	11	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.58	18.00	36.00	45.00																					.58	18.00	36.00	36.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9302	003	0	1	01	01	H9302_003_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.94	60.00	120.00	150.00																					1.94	60.00	120.00	120.00																		60.00				1.94	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	10	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					733.71	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	10	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.58	18.00	36.00	45.00																					.58	18.00	36.00	36.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.16	36.00	72.00	90.00																					1.16	36.00	72.00	72.00																		36.00				1.16	36.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.19	6.00	12.00	15.00																					.19	6.00	12.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	10	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.19	6.00	12.00	18.00																					.19	6.00	12.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9302	007	0	1	01	01	H9302_007_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.19	6.00	12.00	15.00																					.19	6.00	12.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.16	36.00	72.00	90.00																					1.16	36.00	72.00	72.00																		36.00				1.16	36.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	10	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.58	18.00	36.00	45.00																					.58	18.00	36.00	36.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	10	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					416.37	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.94	60.00	120.00	150.00																					1.94	60.00	120.00	120.00																		60.00				1.94	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	010	0	1	01	01	H9302_010_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.19	6.00	12.00	15.00																					.19	6.00	12.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	010	0	1	01	01	H9302_010_0	10	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.58	18.00	36.00	45.00																					.58	18.00	36.00	36.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	010	0	1	01	01	H9302_010_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.16	36.00	72.00	90.00																					1.16	36.00	72.00	72.00																		36.00				1.16	36.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	010	0	1	01	01	H9302_010_0	10	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					788.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	010	0	1	01	01	H9302_010_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.94	60.00	120.00	150.00																					1.94	60.00	120.00	120.00																		60.00				1.94	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	10	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					416.37	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.94	60.00	120.00	150.00																					1.94	60.00	120.00	120.00																		60.00				1.94	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	10	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.58	18.00	36.00	45.00																					.58	18.00	36.00	36.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	1.16	36.00	72.00	90.00																					1.16	36.00	72.00	72.00																		36.00				1.16	36.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	.19	6.00	12.00	15.00																					.19	6.00	12.00	12.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9385	002	0	1	01	01	H9385_002_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	002	0	1	01	01	H9385_002_0	6	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	002	0	1	01	01	H9385_002_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	002	0	1	01	01	H9385_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	002	0	1	01	01	H9385_002_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					642.22	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	002	0	1	01	01	H9385_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.74	85.00	170.00	255.00																					2.74	85.00	170.00	170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	003	0	1	01	01	H9385_003_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9385	003	0	1	01	01	H9385_003_0	6	6	Select Care Drugs	3	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9385	003	0	1	01	01	H9385_003_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	003	0	1	01	01	H9385_003_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	003	0	1	01	01	H9385_003_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	003	0	1	01	01	H9385_003_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	003	0	1	01	01	H9385_003_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					493.44	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	003	0	1	01	01	H9385_003_0	6	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	004	0	1	01	01	H9385_004_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9385	004	0	1	01	01	H9385_004_0	6	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	004	0	1	01	01	H9385_004_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	004	0	1	01	01	H9385_004_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.32	10.00	20.00	30.00																					0.32	10.00	20.00	20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	004	0	1	01	01	H9385_004_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	004	0	1	01	01	H9385_004_0	6	6	Select Care Drugs	3	4	000010	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9385	004	0	1	01	01	H9385_004_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					510.99	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9385	004	0	1	01	01	H9385_004_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.06	95.00	190.00	285.00																					3.06	95.00	190.00	190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9412	003	0	1	04	01	H9412_003_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9412	003	0	1	04	01	H9412_003_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	0.32	10.00		30.00																								30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9412	003	0	1	04	01	H9412_003_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				2			90				31		31	0.10	3.00		9.00																								9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9412	003	0	1	04	01	H9412_003_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	2.58	80.00		240.00																								240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9412	003	0	1	04	01	H9412_003_0	5	5	Specialty Tier	1	4	000010	1	1	010		01			1	31													31		31					745.23	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9412	003	0	1	04	01	H9412_003_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.26	39.00		117.00																								117.00																		39.00				1.26	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	001	0	1	04	01	H9503_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	001	0	1	04	01	H9503_001_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	001	0	1	04	01	H9503_001_0	5	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	001	0	1	04	01	H9503_001_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	001	0	1	04	01	H9503_001_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H9503	001	0	1	04	01	H9503_001_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H9503	001	0	1	04	01	H9503_001_0	5	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H9503	001	0	1	04	01	H9503_001_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H9503	001	0	1	04	01	H9503_001_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H9503	001	0	1	04	01	H9503_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	003	0	1	04	01	H9503_003_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	003	0	1	04	01	H9503_003_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	003	0	1	04	01	H9503_003_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.30	9.00		27.00																												0.30	9.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	003	0	1	04	01	H9503_003_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	003	0	1	04	01	H9503_003_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	003	0	1	04	01	H9503_003_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H9503	003	0	1	04	01	H9503_003_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H9503	003	0	1	04	01	H9503_003_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H9503	003	0	1	04	01	H9503_003_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.30	9.00		27.00																												0.30	9.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H9503	003	0	1	04	01	H9503_003_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
H9503	008	0	1	04	01	H9503_008_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	26																														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	008	0	1	04	01	H9503_008_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	008	0	1	04	01	H9503_008_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	008	0	1	04	01	H9503_008_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	008	0	1	04	01	H9503_008_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	009	0	1	04	01	H9503_009_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	009	0	1	04	01	H9503_009_0	5	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.36	11.00		33.00																												0.36	11.00		0.00				0.36	11.00		33.00				11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	009	0	1	04	01	H9503_009_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	009	0	1	04	01	H9503_009_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	26																														26							26					26				26	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9503	009	0	1	04	01	H9503_009_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9525	001	0	1	01	01	H9525_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.03	1.00	2.00	3.00					.18	6.00	12.00	18.00					.03	1.00	2.00	2.00																		6.00				.18	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9525	001	0	1	01	01	H9525_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.21	7.00	14.00	21.00					.35	12.00	24.00	36.00					.21	7.00	14.00	14.00																		12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9525	001	0	1	01	01	H9525_001_0	5	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9525	001	0	1	01	01	H9525_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.53	86.00	172.00	258.00					2.68	91.00	182.00	273.00					2.53	86.00	258.00	258.00																		91.00				2.68	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9525	001	0	1	01	01	H9525_001_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													73.00	33	33	33					73.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9525	001	0	1	01	01	H9525_001_0	5	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9525	002	0	1	01	01	H9525_002_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.03	1.00	2.00	3.00					.18	6.00	12.00	18.00					.03	1.00	2.00	2.00																		6.00				.18	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9525	002	0	1	01	01	H9525_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.21	7.00	14.00	21.00					.35	12.00	24.00	36.00					.21	7.00	14.00	14.00																		12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9525	002	0	1	01	01	H9525_002_0	5	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9525	002	0	1	01	01	H9525_002_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.53	86.00	172.00	258.00					2.68	91.00	182.00	273.00					2.53	86.00	258.00	258.00																		91.00				2.68	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9525	002	0	1	01	01	H9525_002_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													73.00	33	33	33					73.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9525	002	0	1	01	01	H9525_002_0	5	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	12	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.48	15.00		37.50					.48	15.00		45.00					.48	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	12	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.45	45.00		112.50					1.45	45.00		135.00					1.45	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	12	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	12	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.06	95.00		237.50					3.06	95.00		285.00					3.06	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	10	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.48	15.00		37.50					.48	15.00		45.00					.48	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	10	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	10	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.45	45.00		112.50					1.45	45.00		135.00					1.45	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.06	95.00		237.50					3.06	95.00		285.00					3.06	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	10	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	10	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.48	15.00		37.50					.48	15.00		45.00					.48	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.06	95.00		237.50					3.06	95.00		285.00					3.06	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	10	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.45	45.00		112.50					1.45	45.00		135.00					1.45	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	10	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.45	45.00		112.50					1.45	45.00		135.00					1.45	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	10	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.48	15.00		37.50					.48	15.00		45.00					.48	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	10	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.06	95.00		237.50					3.06	95.00		285.00					3.06	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	10	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.45	45.00		112.50					1.45	45.00		135.00					1.45	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	10	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.48	15.00		37.50					.48	15.00		45.00					.48	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	10	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.06	95.00		237.50					3.06	95.00		285.00					3.06	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	11	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.29	40.00		100.00					1.29	40.00		120.00					1.29	40.00		100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.32	10.00		25.00					.32	10.00		30.00					.32	10.00		25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	11	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	11	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.06	95.00		237.50					3.06	95.00		285.00					3.06	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	11	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9572	003	1	1	04	01	H9572_003_1	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	9	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.32	10.00		25.00					.32	10.00		30.00					.32	10.00		25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	9	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.29	40.00		100.00					1.29	40.00		120.00					1.29	40.00		100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.06	95.00		237.50					3.06	95.00		285.00					3.06	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	9	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9572	003	3	1	04	01	H9572_003_3	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.32	10.00		25.00					.32	10.00		30.00					.32	10.00		25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	9	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.29	40.00		100.00					1.29	40.00		120.00					1.29	40.00		100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.06	95.00		237.50					3.06	95.00		285.00					3.06	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	9	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9572	003	3	1	04	01	H9572_003_3	9	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	9	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.32	10.00		25.00					.32	10.00		30.00					.32	10.00		25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	9	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.29	40.00		100.00					1.29	40.00		120.00					1.29	40.00		100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.06	95.00		237.50					3.06	95.00		285.00					3.06	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	9	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9572	003	6	1	04	01	H9572_003_6	9	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.32	10.00		25.00					.32	10.00		30.00					.32	10.00		25.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	9	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.29	40.00		100.00					1.29	40.00		120.00					1.29	40.00		100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.06	95.00		237.50					3.06	95.00		285.00					3.06	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	9	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.10	3.00		7.50					.10	3.00		9.00					.10	3.00		7.50																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9615	002	0	1	04	01	H9615_002_0	7	5	Select Care Drugs	3	4	010010	1	2	110		01	110		1	30		90				2	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9615	002	0	1	04	01	H9615_002_0	7	5	Select Care Drugs	1	4	010010	1	2	110		01	110		1	30		90				2	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9615	002	0	1	04	01	H9615_002_0	7	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					35.00	33																							33																			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9615	002	0	1	04	01	H9615_002_0	7	3	Non-Preferred Brand	1	4	100100	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9615	002	0	1	04	01	H9615_002_0	7	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.17	35.00		105.00																					1.17	35.00		70.00																		35.00				1.13	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9615	002	0	1	04	01	H9615_002_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.26	8.00		24.00																					.26	8.00		16.00																		8.00				.26	8.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9615	007	0	1	04	01	H9615_007_0	5	5	Select Care Drugs	1	4	010010	1	2	110		01	110		1	30		90				2	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9615	007	0	1	04	01	H9615_007_0	5	5	Select Care Drugs	3	4	010010	1	2	110		01	110		1	30		90				2	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9615	007	0	1	04	01	H9615_007_0	5	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					35.00	33																							33																			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9615	007	0	1	04	01	H9615_007_0	5	3	Non-Preferred Brand	1	4	100100	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9615	007	0	1	04	01	H9615_007_0	5	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.17	35.00		105.00																					1.17	35.00		70.00																		35.00				1.13	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9615	007	0	1	04	01	H9615_007_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9670	004	0	1	04	01	H9670_004_0	9	3	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								285.00																		95.00				3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9670	004	0	1	04	01	H9670_004_0	9	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	31							31						31		31					760.00	33																							33																			33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9670	004	0	1	04	01	H9670_004_0	9	5	Select Care Drugs	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9670	004	0	1	04	01	H9670_004_0	9	1	Generic	1	3	010000	1	2	110		01	100		1	31		90				1			90				31		31	.32	10.00		30.00																								20.00																		10.00				.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9670	004	0	1	04	01	H9670_004_0	9	2	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9699	001	0	1	01	01	H9699_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		3.00																					.10	3.00		3.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	001	0	1	01	01	H9699_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.50	15.00		37.50																					.50	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	001	0	1	01	01	H9699_001_0	6	3	Preferred Brand	1	4	000001	1	1	110		01	110		1	30		90				1	30		90				30		31					50.97	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	001	0	1	01	01	H9699_001_0	6	4	Non-Preferred Brand	1	4	110000	1	1	110		01	110		1	30		90				1	30		90				30		31					30.35	50		50																					50		50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	001	0	1	01	01	H9699_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					511.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9725	001	0	1	01	01	H9725_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00		27.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00		125.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	2.66	80.00	160.00	240.00																					2.66	80.00		230.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31					484.67	33	33	33																					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00		0.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9730	001	0	1	01	01	H9730_001_0	3	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	001	0	1	01	01	H9730_001_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.64	20.00	40.00	60.00												.06	2.00	4.00	4.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	001	0	1	01	01	H9730_001_0	3	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													568.25	25							568.25	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	001	0	1	01	01	H9730_001_0	3	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					2.90	90.00	180.00	270.00												1.29	40.00	80.00	80.00				2.90	90.00	180.00	270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	001	0	1	01	01	H9730_001_0	3	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					1.29	40.00	80.00	120.00												.48	15.00	30.00	30.00				1.29	40.00	80.00	120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	0.00				.16	5.00	10.00	15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	3	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.25	70.00	140.00	210.00					2.74	85.00	170.00	255.00												2.25	70.00	140.00	140.00				2.74	85.00	170.00	255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	3	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.41	13.00	26.00	39.00					.64	20.00	40.00	60.00												.41	13.00	26.00	26.00				.64	20.00	40.00	60.00				20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	4	3	Preferred Brand	1	3	000001	1	2	110		01			1	30		90				1							30		31	1.50	45.00		135.00																																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	4	4	Non-Preferred Brand	1	3	100000	1	2	110		01			1	30		90				1							30		31	3.16	95.00		285.00																																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	4	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31					250.00	32																																										32				32	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01			1	30		90				1							30		31	1.00	30.00		90.00																																										30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	4	1	Preferred Generic	1	3	001000	1	2	110		01			1	30		90				1							30		31	.26	8.00		24.00																																										8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	7	3	Preferred Brand	1	3	000001	1	2	110		01			1	30		90				1							30		31	1.50	45.00		135.00																																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	7	4	Non-Preferred Brand	1	3	100000	1	2	110		01			1	30		90				1							30		31	3.16	95.00		285.00																																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	7	1	Preferred Generic	1	3	001000	1	2	110		01			1	30		90				1							30		31	.26	8.00		24.00																																										8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	7	2	Non-Preferred Generic	1	3	000100	1	2	110		01			1	30		90				1							30		31	1.00	30.00		90.00																																										30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	7	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31					279.64	30																																										30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	001	0	1	04	01	H9847_001_0	9	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.73	22.00	44.00	66.00					.83	25.00	50.00	75.00					.73	22.00	44.00	44.00																		25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	001	0	1	04	01	H9847_001_0	9	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	001	0	1	04	01	H9847_001_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					2.93	88.00	176.00	264.00					2.83	85.00	170.00	255.00																		88.00				2.83	88.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	001	0	1	04	01	H9847_001_0	9	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31														33								33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	001	0	1	04	01	H9847_001_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.10	3.00	6.00	9.00					.20	6.00	12.00	18.00					0.10	3.00	6.00	0.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	005	0	1	04	01	H9847_005_0	10	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.60	18.00	36.00	54.00					.73	22.00	44.00	66.00					.60	18.00	36.00	36.00																		22.00				.70	22.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	005	0	1	04	01	H9847_005_0	10	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00					1.40	42.00	84.00	126.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	005	0	1	04	01	H9847_005_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									2.83	85.00	170.00	255.00					2.93	88.00	176.00	264.00					2.83	85.00	170.00	255.00																		88.00				2.83	88.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	005	0	1	04	01	H9847_005_0	10	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31														33								33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9847	005	0	1	04	01	H9847_005_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.10	3.00	6.00	9.00					.20	6.00	12.00	18.00					0.10	3.00	6.00	0.00																		6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9857	001	0	1	01	01	H9857_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.20	6.00	12.00	18.00																					0.20	6.00	12.00	18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9857	001	0	1	01	01	H9857_001_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9857	001	0	1	01	01	H9857_001_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9857	001	0	1	01	01	H9857_001_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	9.00																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9857	001	0	1	01	01	H9857_001_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9857	001	0	1	01	01	H9857_001_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9859	002	0	1	02	01	H9859_002_0	6	3	Non-Preferred Brand	1	4	100100	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9859	002	0	1	02	01	H9859_002_0	6	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					35.00	33																							33																			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9859	002	0	1	02	01	H9859_002_0	6	5	Select Care Drugs	1	4	010010	1	2	110		01	110		1	30		90				2	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9859	002	0	1	02	01	H9859_002_0	6	5	Select Care Drugs	3	4	010010	1	2	110		01	110		1	30		90				2	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9859	002	0	1	02	01	H9859_002_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9859	002	0	1	02	01	H9859_002_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.17	35.00		105.00																					1.17	35.00		70.00																		35.00				1.13	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9859	013	0	1	02	01	H9859_013_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	.33	10.00		30.00																					.33	10.00		20.00																		10.00				.32	10.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9859	013	0	1	02	01	H9859_013_0	6	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	1.17	35.00		105.00																					1.17	35.00		70.00																		35.00				1.13	35.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9859	013	0	1	02	01	H9859_013_0	6	3	Non-Preferred Brand	1	4	100100	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		180.00																		90.00				2.90	90.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9859	013	0	1	02	01	H9859_013_0	6	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					35.00	33																							33																			33				33	Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9859	013	0	1	02	01	H9859_013_0	6	5	Select Care Drugs	3	4	010010	1	2	110		01	110		1	30		90				2	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9859	013	0	1	02	01	H9859_013_0	6	5	Select Care Drugs	1	4	010010	1	2	110		01	110		1	30		90				2	30		90				30		31	0.00	0.00		0.00																					0.00	0.00		0.00																		0.00				0.00	0.00		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	001	0	1	01	01	H9886_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.50	85.00	170.00	255.00					2.65	90.00	180.00	270.00					2.50	85.00	255.00	255.00																		90.00				2.65	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9886	001	0	1	01	01	H9886_001_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9886	001	0	1	01	01	H9886_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.18	6.00	12.00	18.00					.32	11.00	22.00	33.00					.18	6.00	12.00	12.00																		11.00				.32	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9886	001	0	1	01	01	H9886_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.03	1.00	2.00	3.00					.18	6.00	12.00	18.00					.03	1.00	2.00	2.00																		6.00				.18	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9886	001	0	1	01	01	H9886_001_0	7	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													61.00	33	33	33					61.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9886	001	0	1	01	01	H9886_001_0	7	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9915	001	0	1	01	01	H9915_001_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.13	4.00	8.00	12.00					0.13	4.00	8.00	12.00					0.13	4.00	8.00	12.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	001	0	1	01	01	H9915_001_0	4	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	001	0	1	01	01	H9915_001_0	4	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.16	35.00	70.00	105.00					1.33	40.00	80.00	120.00					1.16	35.00	70.00	105.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	001	0	1	01	01	H9915_001_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.66	80.00	160.00	240.00					2.66	80.00	160.00	240.00					2.66	80.00	160.00	240.00																		80.00				2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	001	0	1	01	01	H9915_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.33	10.00	20.00	30.00					0.33	10.00	20.00	30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9947	001	0	1	04	01	H9947_001_0	7	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													74.00	33	33	33					74.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9947	001	0	1	04	01	H9947_001_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9947	001	0	1	04	01	H9947_001_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9947	001	0	1	04	01	H9947_001_0	7	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.47	16.00	32.00	48.00					.62	21.00	42.00	63.00					.47	16.00	32.00	32.00																		21.00				.62	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9947	001	0	1	04	01	H9947_001_0	7	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9947	001	0	1	04	01	H9947_001_0	7	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9954	001	0	1	01	01	H9954_001_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9954	001	0	1	01	01	H9954_001_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.12	4.00	8.00	12.00					.26	9.00	18.00	27.00					.12	4.00	8.00	8.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9954	001	0	1	01	01	H9954_001_0	7	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9954	001	0	1	01	01	H9954_001_0	7	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													48.00	33	33	33					48.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9954	001	0	1	01	01	H9954_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9954	001	0	1	01	01	H9954_001_0	7	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.24	8.00	16.00	24.00					.38	13.00	26.00	39.00					.24	8.00	16.00	16.00																		13.00				.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	8	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	1.06	33.00		99.00																					1.06	33.00		99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	8	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	.32	10.00		30.00																					.32	10.00		30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	8	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	31		90				1	31		90				31		31	1.45	45.00		135.00																					1.45	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	8	4	Non-Preferred Brand	1	3	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	3.06	95.00		285.00																					3.06	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	8	5	Specialty Tier	1	3	101101	1	1	110		01	110		1	31		90				1	31		90				31		31					1214.00	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.30	9.00		27.00																															18.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					544.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															20.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					836.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5287	001	0	1	31	11	R5287_001_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.26	8.00		24.00																															16.00							24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5287	001	0	1	31	11	R5287_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.13	4.00		12.00																															8.00							12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5287	001	0	1	31	11	R5287_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5287	001	0	1	31	11	R5287_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					584.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5287	001	0	1	31	11	R5287_001_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					574.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	6	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	6	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	6	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	32																														32							32					32				32	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	6	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	002	0	1	31	11	R5826_002_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
R5826	002	0	1	31	11	R5826_002_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	002	0	1	31	11	R5826_002_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	002	0	1	31	11	R5826_002_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	002	0	1	31	11	R5826_002_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	003	0	1	31	11	R5826_003_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	003	0	1	31	11	R5826_003_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	003	0	1	31	11	R5826_003_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	003	0	1	31	11	R5826_003_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	003	0	1	31	11	R5826_003_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	003	0	1	31	11	R5826_003_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	003	0	1	31	11	R5826_003_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	003	0	1	31	11	R5826_003_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	003	0	1	31	11	R5826_003_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	003	0	1	31	11	R5826_003_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
R5826	005	0	1	31	11	R5826_005_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	005	0	1	31	11	R5826_005_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.10	3.00		9.00																												0.10	3.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
R5826	005	0	1	31	11	R5826_005_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.26	8.00		24.00																												0.26	8.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	005	0	1	31	11	R5826_005_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.33	40.00		120.00																												1.33	40.00		110.00				1.33	40.00		120.00				40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	005	0	1	31	11	R5826_005_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.83	85.00		255.00																												2.83	85.00		245.00				2.83	85.00		255.00				85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	005	0	1	31	11	R5826_005_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_0	3	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.40	42.00		126.00																												1.40	42.00		116.00				1.40	42.00		126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.10	93.00		279.00																												3.10	93.00		269.00				3.10	93.00		279.00				93.00				3.00	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	3	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	008	0	1	31	11	R5826_008_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	008	0	1	31	11	R5826_008_0	3	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.60	18.00		54.00																												0.60	18.00		0.00				0.60	18.00		54.00				18.00				0.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	008	0	1	31	11	R5826_008_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
R5826	008	0	1	31	11	R5826_008_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	011	0	1	31	11	R5826_011_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
R5826	011	0	1	31	11	R5826_011_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	011	0	1	31	11	R5826_011_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	011	0	1	31	11	R5826_011_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	011	0	1	31	11	R5826_011_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	30																														30							30					30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	011	0	1	31	11	R5826_011_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.16	5.00		15.00																												0.16	5.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	8	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
R5826	012	0	1	31	11	R5826_012_0	8	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	012	0	1	31	11	R5826_012_0	8	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	012	0	1	31	11	R5826_012_0	8	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.96	89.00		267.00																												2.96	89.00		257.00				2.96	89.00		267.00				89.00				2.87	89.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	012	0	1	31	11	R5826_012_0	8	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	33																														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	012	0	1	31	11	R5826_012_0	8	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.23	7.00		21.00																												0.23	7.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	8	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	8	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	2.96	89.00		267.00																												2.96	89.00		257.00				2.96	89.00		267.00				89.00				2.87	89.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_0	6	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	28																														28							28					28				28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_0	6	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_0	6	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_0	6	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	4	2	Non-Preferred Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	074	0	1	31	11	R5826_074_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	074	0	1	31	11	R5826_074_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	074	0	1	31	11	R5826_074_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	074	0	1	31	11	R5826_074_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	1
R5826	074	0	1	31	11	R5826_074_0	4	2	Non-Preferred Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.50	15.00		45.00																												0.50	15.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	6	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.16	95.00		285.00																												3.16	95.00		275.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	29																														29							29					29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	6	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.50	45.00		135.00																												1.50	45.00		125.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	6	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.40	12.00		36.00																												0.40	12.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	6	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.13	4.00		12.00																												0.13	4.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00	90.00		270.00																												3.00	90.00		260.00				3.00	90.00		270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					1.00	25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	1.40	42.00		126.00																												1.40	42.00		116.00				1.40	42.00		126.00				42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	4	2	Non-Preferred Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	0.43	13.00		39.00																												0.43	13.00		0.00				0.43	13.00		39.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.20	6.00		18.00																												0.20	6.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5941	008	0	1	31	11	R5941_008_0	8	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.44	15.00	30.00	45.00					.59	20.00	40.00	60.00					.44	15.00	30.00	30.00																		20.00				.59	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
R5941	008	0	1	31	11	R5941_008_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
R5941	008	0	1	31	11	R5941_008_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
R5941	008	0	1	31	11	R5941_008_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
R5941	008	0	1	31	11	R5941_008_0	8	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													78.00	33	33	33					78.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
R5941	008	0	1	31	11	R5941_008_0	8	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
R5941	009	0	1	31	11	R5941_009_0	8	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
R5941	009	0	1	31	11	R5941_009_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.65	90.00	180.00	270.00					2.79	95.00	190.00	285.00					2.65	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
R5941	009	0	1	31	11	R5941_009_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.18	40.00	80.00	120.00					1.32	45.00	90.00	135.00					1.18	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
R5941	009	0	1	31	11	R5941_009_0	8	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.44	15.00	30.00	45.00					.59	20.00	40.00	60.00					.44	15.00	30.00	30.00																		20.00				.59	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
R5941	009	0	1	31	11	R5941_009_0	8	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													67.00	33	33	33					67.00	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
R5941	009	0	1	31	11	R5941_009_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.15	5.00	10.00	15.00					.29	10.00	20.00	30.00					.15	5.00	10.00	10.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.30	9.00		27.00																															18.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					524.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															20.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	5	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					701.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7439	001	0	1	31	11	R7439_001_0	10	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	1.50	45.00		135.00																								90.00																		45.00				1.32	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7439	001	0	1	31	11	R7439_001_0	10	4	Specialty Tier	1	4	010010	1	1	110		01			1	30		90				2							30		34					363.47	33		33																																								33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7439	001	0	1	31	11	R7439_001_0	10	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	3.16	95.00		285.00																								190.00																		95.00				2.79	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7439	001	0	1	31	11	R7439_001_0	10	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		34	0.23	7.00		21.00																								7.00																		7.00				0.20	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7439	003	0	1	31	11	R7439_003_0	9	4	Specialty Tier	1	4	010010	1	1	110		01			1	30		90				2							30		34					416.74	33		33																																								33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7439	003	0	1	31	11	R7439_003_0	9	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				2			90				30		34	0.23	7.00		21.00																								7.00																		7.00				0.20	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7439	003	0	1	31	11	R7439_003_0	9	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	3.16	95.00		285.00																								190.00																		95.00				2.79	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7439	003	0	1	31	11	R7439_003_0	9	1	Generic	3	4	010000	1	2	110		01	100		1	30		90				2			90				30		34	0.23	7.00		21.00																								7.00																		7.00				0.20	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
R7439	003	0	1	31	11	R7439_003_0	9	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	1.50	45.00		135.00																								90.00																		45.00				1.32	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.26	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					620.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	009	0	1	31	11	R9896_009_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.13	4.00		12.00																															8.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	009	0	1	31	11	R9896_009_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	0.30	9.00		27.00																															18.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	009	0	1	31	11	R9896_009_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	009	0	1	31	11	R9896_009_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	009	0	1	31	11	R9896_009_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					580.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	012	0	1	31	11	R9896_012_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	.16	5.00		15.00																															10.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	012	0	1	31	11	R9896_012_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	.33	10.00		30.00																															20.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	012	0	1	31	11	R9896_012_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	1.50	45.00		135.00																															125.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	012	0	1	31	11	R9896_012_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01		100	1	30		90				1						90	30		31	3.16	95.00		285.00																															275.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	012	0	1	31	11	R9896_012_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31					813.00	33		33																														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	001	0		29	10	S0064_001_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													79.64	43		43					92.63	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	001	0		29	10	S0064_001_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.13	34.00		85.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	001	0		29	10	S0064_001_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	001	0		29	10	S0064_001_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.33	10.00		25.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	001	0		29	10	S0064_001_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	002	0		29	10	S0064_002_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													79.11	41		41					94.58	49		49																								49				49	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	002	0		29	10	S0064_002_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	002	0		29	10	S0064_002_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.67	20.00		50.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	002	0		29	10	S0064_002_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	002	0		29	10	S0064_002_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	003	0		29	10	S0064_003_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	003	0		29	10	S0064_003_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.63	19.00		47.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	003	0		29	10	S0064_003_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	003	0		29	10	S0064_003_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													81.66	42		42					93.36	48		48																								48				48	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	003	0		29	10	S0064_003_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	004	0		29	10	S0064_004_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	004	0		29	10	S0064_004_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	004	0		29	10	S0064_004_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	004	0		29	10	S0064_004_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													75.29	40		40					94.15	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	004	0		29	10	S0064_004_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	005	0		29	10	S0064_005_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.63	19.00		47.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	005	0		29	10	S0064_005_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	005	0		29	10	S0064_005_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	005	0		29	10	S0064_005_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	005	0		29	10	S0064_005_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													82.33	43		43					93.85	49		49																								49				49	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	006	0		29	10	S0064_006_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													71.50	39		39					91.69	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	006	0		29	10	S0064_006_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	006	0		29	10	S0064_006_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.57	17.00		42.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	006	0		29	10	S0064_006_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	006	0		29	10	S0064_006_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	007	0		29	10	S0064_007_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													72.72	40		40					90.93	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	007	0		29	10	S0064_007_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	007	0		29	10	S0064_007_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.57	17.00		42.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	007	0		29	10	S0064_007_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	007	0		29	10	S0064_007_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	008	0		29	10	S0064_008_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	008	0		29	10	S0064_008_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.67	20.00		50.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	008	0		29	10	S0064_008_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	008	0		29	10	S0064_008_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													75.56	41		41					92.17	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	008	0		29	10	S0064_008_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	009	0		29	10	S0064_009_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	009	0		29	10	S0064_009_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.57	17.00		42.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	009	0		29	10	S0064_009_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													80.49	44		44					91.49	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	009	0		29	10	S0064_009_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	009	0		29	10	S0064_009_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	010	0		29	10	S0064_010_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													72.53	40		40					90.69	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	010	0		29	10	S0064_010_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	010	0		29	10	S0064_010_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.63	19.00		47.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	010	0		29	10	S0064_010_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	010	0		29	10	S0064_010_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	011	0		29	10	S0064_011_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													82.99	44		44					94.34	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	011	0		29	10	S0064_011_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	011	0		29	10	S0064_011_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.67	20.00		50.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	011	0		29	10	S0064_011_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	011	0		29	10	S0064_011_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	012	0		29	10	S0064_012_0	2	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	012	0		29	10	S0064_012_0	2	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	012	0		29	10	S0064_012_0	2	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	012	0		29	10	S0064_012_0	2	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													77.88	44		44					88.52	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	012	0		29	10	S0064_012_0	2	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	013	0		29	10	S0064_013_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	013	0		29	10	S0064_013_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.63	19.00		47.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	013	0		29	10	S0064_013_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	013	0		29	10	S0064_013_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													73.17	39		39					93.83	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	013	0		29	10	S0064_013_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	014	0		29	10	S0064_014_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													70.73	39		39					90.72	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	014	0		29	10	S0064_014_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	014	0		29	10	S0064_014_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	014	0		29	10	S0064_014_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	014	0		29	10	S0064_014_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	015	0		29	10	S0064_015_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.57	17.00		42.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	015	0		29	10	S0064_015_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	015	0		29	10	S0064_015_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	015	0		29	10	S0064_015_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													70.69	40		40					88.39	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	015	0		29	10	S0064_015_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	016	0		29	10	S0064_016_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	016	0		29	10	S0064_016_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.63	19.00		47.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	016	0		29	10	S0064_016_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	016	0		29	10	S0064_016_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													80.66	43		43					93.83	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	016	0		29	10	S0064_016_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	017	0		29	10	S0064_017_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.63	19.00		47.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	017	0		29	10	S0064_017_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	017	0		29	10	S0064_017_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	017	0		29	10	S0064_017_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	017	0		29	10	S0064_017_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													71.53	39		39					91.73	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	018	0		29	10	S0064_018_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	018	0		29	10	S0064_018_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	018	0		29	10	S0064_018_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	018	0		29	10	S0064_018_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													68.50	38		38					90.16	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	018	0		29	10	S0064_018_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	019	0		29	10	S0064_019_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	019	0		29	10	S0064_019_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.53	16.00		40.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	019	0		29	10	S0064_019_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													79.51	44		44					90.39	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	019	0		29	10	S0064_019_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	019	0		29	10	S0064_019_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	020	0		29	10	S0064_020_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	020	0		29	10	S0064_020_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													67.23	38		38					88.49	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	020	0		29	10	S0064_020_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	020	0		29	10	S0064_020_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	020	0		29	10	S0064_020_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.57	17.00		42.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	021	0		29	10	S0064_021_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	021	0		29	10	S0064_021_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	021	0		29	10	S0064_021_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													65.13	37		37					88.04	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	021	0		29	10	S0064_021_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	021	0		29	10	S0064_021_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.53	16.00		40.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	022	0		29	10	S0064_022_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	022	0		29	10	S0064_022_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													79.43	43		43					92.39	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	022	0		29	10	S0064_022_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	022	0		29	10	S0064_022_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	022	0		29	10	S0064_022_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	023	0		29	10	S0064_023_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	023	0		29	10	S0064_023_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	023	0		29	10	S0064_023_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	023	0		29	10	S0064_023_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													80.37	44		44					91.36	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	023	0		29	10	S0064_023_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.63	19.00		47.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	024	0		29	10	S0064_024_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													80.62	44		44					91.64	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	024	0		29	10	S0064_024_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	024	0		29	10	S0064_024_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.50	15.00		37.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	024	0		29	10	S0064_024_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	024	0		29	10	S0064_024_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	025	0		29	10	S0064_025_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.57	17.00		42.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	025	0		29	10	S0064_025_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	025	0		29	10	S0064_025_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	025	0		29	10	S0064_025_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													72.60	38		38					93.64	49		49																								49				49	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	025	0		29	10	S0064_025_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	026	0		29	10	S0064_026_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	026	0		29	10	S0064_026_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	026	0		29	10	S0064_026_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	026	0		29	10	S0064_026_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													77.89	41		41					93.12	49		49																								49				49	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	026	0		29	10	S0064_026_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	027	0		29	10	S0064_027_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	027	0		29	10	S0064_027_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	027	0		29	10	S0064_027_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	027	0		29	10	S0064_027_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	027	0		29	10	S0064_027_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													77.37	41		41					94.38	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	028	0		29	10	S0064_028_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	028	0		29	10	S0064_028_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.57	17.00		42.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	028	0		29	10	S0064_028_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	028	0		29	10	S0064_028_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													79.13	44		44					89.95	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	028	0		29	10	S0064_028_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	029	0		29	10	S0064_029_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	029	0		29	10	S0064_029_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	029	0		29	10	S0064_029_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													83.52	44		44					94.94	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	029	0		29	10	S0064_029_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	029	0		29	10	S0064_029_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	030	0		29	10	S0064_030_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.53	16.00		40.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	030	0		29	10	S0064_030_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													75.20	41		41					91.74	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	030	0		29	10	S0064_030_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	030	0		29	10	S0064_030_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	030	0		29	10	S0064_030_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	031	0		29	10	S0064_031_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													79.89	43		43					92.93	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	031	0		29	10	S0064_031_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	031	0		29	10	S0064_031_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.57	17.00		42.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	031	0		29	10	S0064_031_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	031	0		29	10	S0064_031_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	032	0		29	10	S0064_032_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	032	0		29	10	S0064_032_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													80.99	43		43					94.21	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	032	0		29	10	S0064_032_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	032	0		29	10	S0064_032_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.57	17.00		42.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	032	0		29	10	S0064_032_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	033	0		29	10	S0064_033_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	033	0		29	10	S0064_033_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													76.67	40		40					93.95	49		49																								49				49	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	033	0		29	10	S0064_033_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	033	0		29	10	S0064_033_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	033	0		29	10	S0064_033_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	034	0		29	10	S0064_034_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.13	4.00		10.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	034	0		29	10	S0064_034_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									0.87	26.00		65.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	034	0		29	10	S0064_034_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													54.98	35		35					78.57	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	034	0		29	10	S0064_034_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	034	0		29	10	S0064_034_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	035	0		29	10	S0064_035_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01			1				30		92	1							30		31									0.63	19.00		47.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	035	0		29	10	S0064_035_0	1	3	Preferred Brand	1	2	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	035	0		29	10	S0064_035_0	1	4	Non-Preferred Brand	1	2	100000	1	1		110	01			1				30		92	1							30		31													79.50	42		42					94.68	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	035	0		29	10	S0064_035_0	1	5	Specialty Tier	1	2	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	035	0		29	10	S0064_035_0	1	1	Preferred Generic	1	2	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	036	0		29	10	S0064_036_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	036	0		29	10	S0064_036_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.33	10.00		25.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	036	0		29	10	S0064_036_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	036	0		29	10	S0064_036_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	036	0		29	10	S0064_036_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													54.80	41		41					66.87	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	036	0		29	10	S0064_036_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									0.83	25.00		62.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	037	0		29	10	S0064_037_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	037	0		29	10	S0064_037_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	037	0		29	10	S0064_037_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	037	0		29	10	S0064_037_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													57.46	41		41					70.11	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	037	0		29	10	S0064_037_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	037	0		29	10	S0064_037_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	038	0		29	10	S0064_038_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	038	0		29	10	S0064_038_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	038	0		29	10	S0064_038_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	038	0		29	10	S0064_038_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	038	0		29	10	S0064_038_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	038	0		29	10	S0064_038_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													56.70	41		41					69.19	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	039	0		29	10	S0064_039_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													55.96	41		41					68.28	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	039	0		29	10	S0064_039_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	039	0		29	10	S0064_039_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	039	0		29	10	S0064_039_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	039	0		29	10	S0064_039_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	039	0		29	10	S0064_039_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	040	0		29	10	S0064_040_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	040	0		29	10	S0064_040_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	040	0		29	10	S0064_040_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	040	0		29	10	S0064_040_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	040	0		29	10	S0064_040_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	040	0		29	10	S0064_040_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													56.15	41		41					68.51	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	041	0		29	10	S0064_041_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.03	31.00		77.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	041	0		29	10	S0064_041_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	041	0		29	10	S0064_041_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	041	0		29	10	S0064_041_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													56.12	41		41					68.47	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	041	0		29	10	S0064_041_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	041	0		29	10	S0064_041_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	042	0		29	10	S0064_042_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	042	0		29	10	S0064_042_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													55.11	41		41					67.25	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	042	0		29	10	S0064_042_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	042	0		29	10	S0064_042_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.03	31.00		77.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	042	0		29	10	S0064_042_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	042	0		29	10	S0064_042_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	043	0		29	10	S0064_043_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	043	0		29	10	S0064_043_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													55.42	41		41					67.62	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	043	0		29	10	S0064_043_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	043	0		29	10	S0064_043_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	043	0		29	10	S0064_043_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	043	0		29	10	S0064_043_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	044	0		29	10	S0064_044_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	044	0		29	10	S0064_044_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	044	0		29	10	S0064_044_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.10	33.00		82.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	044	0		29	10	S0064_044_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													55.25	41		41					67.42	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	044	0		29	10	S0064_044_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	044	0		29	10	S0064_044_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	045	0		29	10	S0064_045_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	045	0		29	10	S0064_045_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	045	0		29	10	S0064_045_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	045	0		29	10	S0064_045_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	045	0		29	10	S0064_045_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	045	0		29	10	S0064_045_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													54.55	41		41					66.56	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	046	0		29	10	S0064_046_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	046	0		29	10	S0064_046_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	046	0		29	10	S0064_046_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	046	0		29	10	S0064_046_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	046	0		29	10	S0064_046_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	046	0		29	10	S0064_046_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													56.39	41		41					68.81	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	047	0		29	10	S0064_047_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	047	0		29	10	S0064_047_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	047	0		29	10	S0064_047_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.13	34.00		85.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	047	0		29	10	S0064_047_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													54.72	41		41					66.77	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	047	0		29	10	S0064_047_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	047	0		29	10	S0064_047_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	048	0		29	10	S0064_048_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	048	0		29	10	S0064_048_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	048	0		29	10	S0064_048_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.10	33.00		82.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	048	0		29	10	S0064_048_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	048	0		29	10	S0064_048_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	048	0		29	10	S0064_048_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													56.54	41		41					68.99	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	049	0		29	10	S0064_049_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	049	0		29	10	S0064_049_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	049	0		29	10	S0064_049_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													55.30	41		41					67.48	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	049	0		29	10	S0064_049_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	049	0		29	10	S0064_049_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.07	32.00		80.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	049	0		29	10	S0064_049_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	050	0		29	10	S0064_050_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	050	0		29	10	S0064_050_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	050	0		29	10	S0064_050_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													54.66	41		41					66.70	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	050	0		29	10	S0064_050_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.07	32.00		80.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	050	0		29	10	S0064_050_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	050	0		29	10	S0064_050_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	051	0		29	10	S0064_051_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	051	0		29	10	S0064_051_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	051	0		29	10	S0064_051_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.13	34.00		85.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	051	0		29	10	S0064_051_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													56.74	41		41					69.23	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	051	0		29	10	S0064_051_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	051	0		29	10	S0064_051_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	052	0		29	10	S0064_052_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.10	33.00		82.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	052	0		29	10	S0064_052_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													55.09	41		41					67.23	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	052	0		29	10	S0064_052_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	052	0		29	10	S0064_052_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	052	0		29	10	S0064_052_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	052	0		29	10	S0064_052_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	053	0		29	10	S0064_053_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.07	32.00		80.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	053	0		29	10	S0064_053_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	053	0		29	10	S0064_053_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	053	0		29	10	S0064_053_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													54.83	41		41					66.91	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	053	0		29	10	S0064_053_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	053	0		29	10	S0064_053_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	054	0		29	10	S0064_054_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	054	0		29	10	S0064_054_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	054	0		29	10	S0064_054_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													54.20	41		41					66.13	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	054	0		29	10	S0064_054_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	054	0		29	10	S0064_054_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	054	0		29	10	S0064_054_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.00	30.00		75.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	055	0		29	10	S0064_055_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	055	0		29	10	S0064_055_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	055	0		29	10	S0064_055_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													54.38	41		41					66.36	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	055	0		29	10	S0064_055_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.00	30.00		75.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	055	0		29	10	S0064_055_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	055	0		29	10	S0064_055_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	056	0		29	10	S0064_056_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	056	0		29	10	S0064_056_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	056	0		29	10	S0064_056_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.00	30.00		75.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	056	0		29	10	S0064_056_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	056	0		29	10	S0064_056_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	056	0		29	10	S0064_056_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													53.88	41		41					65.75	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	057	0		29	10	S0064_057_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	057	0		29	10	S0064_057_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													55.38	41		41					67.57	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	057	0		29	10	S0064_057_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.13	34.00		85.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	057	0		29	10	S0064_057_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	057	0		29	10	S0064_057_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	057	0		29	10	S0064_057_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	058	0		29	10	S0064_058_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	058	0		29	10	S0064_058_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	058	0		29	10	S0064_058_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	058	0		29	10	S0064_058_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													55.50	41		41					67.73	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	058	0		29	10	S0064_058_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	058	0		29	10	S0064_058_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	059	0		29	10	S0064_059_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	059	0		29	10	S0064_059_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	059	0		29	10	S0064_059_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.00	30.00		75.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	059	0		29	10	S0064_059_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	059	0		29	10	S0064_059_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													54.14	41		41					66.07	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	059	0		29	10	S0064_059_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	060	0		29	10	S0064_060_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													54.31	41		41					66.27	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	060	0		29	10	S0064_060_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	060	0		29	10	S0064_060_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	060	0		29	10	S0064_060_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	060	0		29	10	S0064_060_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	060	0		29	10	S0064_060_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.00	30.00		75.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	061	0		29	10	S0064_061_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	061	0		29	10	S0064_061_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	061	0		29	10	S0064_061_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													57.33	41		41					69.96	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	061	0		29	10	S0064_061_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	061	0		29	10	S0064_061_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	061	0		29	10	S0064_061_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.07	32.00		80.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	062	0		29	10	S0064_062_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													55.17	41		41					67.32	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	062	0		29	10	S0064_062_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	062	0		29	10	S0064_062_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	062	0		29	10	S0064_062_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.03	31.00		77.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	062	0		29	10	S0064_062_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	062	0		29	10	S0064_062_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	063	0		29	10	S0064_063_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	063	0		29	10	S0064_063_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.07	32.00		80.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	063	0		29	10	S0064_063_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													53.78	41		41					65.63	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	063	0		29	10	S0064_063_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	063	0		29	10	S0064_063_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	063	0		29	10	S0064_063_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	064	0		29	10	S0064_064_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	064	0		29	10	S0064_064_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	064	0		29	10	S0064_064_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.10	33.00		82.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	064	0		29	10	S0064_064_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	064	0		29	10	S0064_064_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	064	0		29	10	S0064_064_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													56.64	41		41					69.11	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	065	0		29	10	S0064_065_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													54.24	41		41					66.18	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	065	0		29	10	S0064_065_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	065	0		29	10	S0064_065_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	065	0		29	10	S0064_065_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.00	30.00		75.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	065	0		29	10	S0064_065_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.57	17.00		42.50					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	065	0		29	10	S0064_065_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	066	0		29	10	S0064_066_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.00	30.00		75.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	066	0		29	10	S0064_066_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	066	0		29	10	S0064_066_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	066	0		29	10	S0064_066_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													54.90	41		41					66.98	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	066	0		29	10	S0064_066_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	066	0		29	10	S0064_066_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	067	0		29	10	S0064_067_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	067	0		29	10	S0064_067_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.07	32.00		80.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	067	0		29	10	S0064_067_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	067	0		29	10	S0064_067_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													55.70	41		41					67.96	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	067	0		29	10	S0064_067_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	067	0		29	10	S0064_067_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	068	0		29	10	S0064_068_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	068	0		29	10	S0064_068_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	068	0		29	10	S0064_068_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.00	30.00		75.00					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	068	0		29	10	S0064_068_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													53.65	41		41					65.47	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	068	0		29	10	S0064_068_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	068	0		29	10	S0064_068_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	069	0		29	10	S0064_069_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	069	0		29	10	S0064_069_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.33	10.00		25.00					0.67	20.00		50.00																										20.00				0.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	069	0		29	10	S0064_069_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									0.67	20.00		50.00					1.17	35.00		87.50																										35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	069	0		29	10	S0064_069_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													43.82	36		36					54.81	45		45																								45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	069	0		29	10	S0064_069_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	069	0		29	10	S0064_069_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0064	070	0		29	10	S0064_070_0	1	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	070	0		29	10	S0064_070_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01			1				30		92	1							30		31									0.60	18.00		45.00					1.10	33.00		82.50																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	070	0		29	10	S0064_070_0	1	3	Preferred Brand	1	4	010001	1	2		110	01			1				30		92	1							30		31									1.17	35.00		87.50					1.50	45.00		112.50																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	070	0		29	10	S0064_070_0	1	4	Non-Preferred Brand	1	4	100000	1	1		110	01			1				30		92	1							30		31													56.47	41		41					68.91	50		50																								50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	070	0		29	10	S0064_070_0	1	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		92	2							30		31													1.00	25		25					1.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0064	070	0		29	10	S0064_070_0	1	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		92	1							30		31									0.00	0.00		0.00					0.33	10.00		25.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0128	003	0		29	10	S0128_003_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.76	25		25					19.43	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	003	0		29	10	S0128_003_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	003	0		29	10	S0128_003_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	003	0		29	10	S0128_003_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	003	0		29	10	S0128_003_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													71.24	40		40					88.06	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	004	0		29	10	S0128_004_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	004	0		29	10	S0128_004_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													74.14	40		40					91.68	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	004	0		29	10	S0128_004_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													16.43	25		25					20.26	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	004	0		29	10	S0128_004_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	004	0		29	10	S0128_004_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	005	0		29	10	S0128_005_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													72.60	40		40					89.74	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	005	0		29	10	S0128_005_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	005	0		29	10	S0128_005_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													16.04	25		25					19.77	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	005	0		29	10	S0128_005_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	005	0		29	10	S0128_005_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	006	0		29	10	S0128_006_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	006	0		29	10	S0128_006_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	006	0		29	10	S0128_006_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													16.36	25		25					20.18	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	006	0		29	10	S0128_006_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	006	0		29	10	S0128_006_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													73.90	40		40					91.38	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	007	0		29	10	S0128_007_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	007	0		29	10	S0128_007_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	007	0		29	10	S0128_007_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.58	25		25					19.21	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	007	0		29	10	S0128_007_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													70.47	40		40					87.11	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	007	0		29	10	S0128_007_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	008	0		29	10	S0128_008_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	008	0		29	10	S0128_008_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	008	0		29	10	S0128_008_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.46	25		25					19.06	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	008	0		29	10	S0128_008_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	008	0		29	10	S0128_008_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													69.80	40		40					86.30	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	009	0		29	10	S0128_009_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	009	0		29	10	S0128_009_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	009	0		29	10	S0128_009_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.67	25		25					19.32	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	009	0		29	10	S0128_009_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													70.77	40		40					87.50	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	009	0		29	10	S0128_009_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	010	0		29	10	S0128_010_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	010	0		29	10	S0128_010_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													70.22	40		40					86.84	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	010	0		29	10	S0128_010_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.57	25		25					19.21	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	010	0		29	10	S0128_010_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	010	0		29	10	S0128_010_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	011	0		29	10	S0128_011_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	011	0		29	10	S0128_011_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													69.91	40		40					86.43	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	011	0		29	10	S0128_011_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.47	25		25					19.07	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	011	0		29	10	S0128_011_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	011	0		29	10	S0128_011_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	012	0		29	10	S0128_012_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	012	0		29	10	S0128_012_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	012	0		29	10	S0128_012_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													72.60	40		40					89.79	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	012	0		29	10	S0128_012_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													16.09	25		25					19.85	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	012	0		29	10	S0128_012_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	013	0		29	10	S0128_013_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	013	0		29	10	S0128_013_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													67.85	40		40					83.88	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	013	0		29	10	S0128_013_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.02	25		25					18.52	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	013	0		29	10	S0128_013_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.16	5.00		15.00					0.16	5.00		15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	013	0		29	10	S0128_013_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	014	0		29	10	S0128_014_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	014	0		29	10	S0128_014_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	014	0		29	10	S0128_014_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													72.03	40		40					89.06	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	014	0		29	10	S0128_014_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.94	25		25					19.66	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	014	0		29	10	S0128_014_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	015	0		29	10	S0128_015_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	015	0		29	10	S0128_015_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													69.54	40		40					85.97	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	015	0		29	10	S0128_015_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.39	25		25					18.97	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	015	0		29	10	S0128_015_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	015	0		29	10	S0128_015_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	016	0		29	10	S0128_016_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	016	0		29	10	S0128_016_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	016	0		29	10	S0128_016_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													14.95	25		25					18.44	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	016	0		29	10	S0128_016_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													67.48	40		40					83.45	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	016	0		29	10	S0128_016_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	017	0		29	10	S0128_017_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	017	0		29	10	S0128_017_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	017	0		29	10	S0128_017_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.92	25		25					19.64	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	017	0		29	10	S0128_017_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													71.96	40		40					88.97	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	017	0		29	10	S0128_017_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	018	0		29	10	S0128_018_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	018	0		29	10	S0128_018_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	018	0		29	10	S0128_018_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.65	25		25					19.31	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	018	0		29	10	S0128_018_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													70.57	40		40					87.28	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	018	0		29	10	S0128_018_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	019	0		29	10	S0128_019_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	019	0		29	10	S0128_019_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	019	0		29	10	S0128_019_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.24	25		25					18.80	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	019	0		29	10	S0128_019_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													68.77	40		40					85.05	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	019	0		29	10	S0128_019_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	020	0		29	10	S0128_020_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	020	0		29	10	S0128_020_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	020	0		29	10	S0128_020_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.43	25		25					19.02	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	020	0		29	10	S0128_020_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	020	0		29	10	S0128_020_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													69.83	40		40					86.30	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	021	0		29	10	S0128_021_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	021	0		29	10	S0128_021_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.16	5.00		15.00					0.16	5.00		15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	021	0		29	10	S0128_021_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.07	25		25					18.57	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	021	0		29	10	S0128_021_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													68.18	40		40					84.26	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	021	0		29	10	S0128_021_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	022	0		29	10	S0128_022_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	022	0		29	10	S0128_022_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.16	5.00		15.00					0.16	5.00		15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	022	0		29	10	S0128_022_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													67.73	40		40					83.76	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	022	0		29	10	S0128_022_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.01	25		25					18.51	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	022	0		29	10	S0128_022_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	023	0		29	10	S0128_023_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	023	0		29	10	S0128_023_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	023	0		29	10	S0128_023_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	023	0		29	10	S0128_023_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.79	25		25					19.48	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	023	0		29	10	S0128_023_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													71.25	40		40					88.13	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	024	0		29	10	S0128_024_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.57	25		25					19.19	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	024	0		29	10	S0128_024_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													70.40	40		40					87.02	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	024	0		29	10	S0128_024_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	024	0		29	10	S0128_024_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	024	0		29	10	S0128_024_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	025	0		29	10	S0128_025_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	025	0		29	10	S0128_025_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	025	0		29	10	S0128_025_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.61	25		25					19.25	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	025	0		29	10	S0128_025_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													70.46	40		40					87.13	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	025	0		29	10	S0128_025_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	026	0		29	10	S0128_026_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	026	0		29	10	S0128_026_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	026	0		29	10	S0128_026_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													16.30	25		25					20.12	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	026	0		29	10	S0128_026_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	026	0		29	10	S0128_026_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													73.56	40		40					90.99	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	027	0		29	10	S0128_027_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	027	0		29	10	S0128_027_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	027	0		29	10	S0128_027_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													16.29	25		25					20.09	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	027	0		29	10	S0128_027_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													73.75	40		40					91.17	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	027	0		29	10	S0128_027_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	028	0		29	10	S0128_028_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	028	0		29	10	S0128_028_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	028	0		29	10	S0128_028_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													72.55	40		40					89.72	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	028	0		29	10	S0128_028_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													16.07	25		25					19.82	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	028	0		29	10	S0128_028_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	029	0		29	10	S0128_029_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													69.80	40		40					86.26	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	029	0		29	10	S0128_029_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.41	25		25					18.99	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	029	0		29	10	S0128_029_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.16	5.00		15.00					0.16	5.00		15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	029	0		29	10	S0128_029_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	029	0		29	10	S0128_029_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	030	0		29	10	S0128_030_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													73.14	40		40					90.46	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	030	0		29	10	S0128_030_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													16.21	25		25					20.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	030	0		29	10	S0128_030_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	030	0		29	10	S0128_030_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	030	0		29	10	S0128_030_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	031	0		29	10	S0128_031_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	031	0		29	10	S0128_031_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	031	0		29	10	S0128_031_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.54	25		25					19.17	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	031	0		29	10	S0128_031_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													70.20	40		40					86.80	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	031	0		29	10	S0128_031_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	032	0		29	10	S0128_032_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													71.35	40		40					88.19	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	032	0		29	10	S0128_032_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													15.75	25		25					19.42	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	032	0		29	10	S0128_032_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	032	0		29	10	S0128_032_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	032	0		29	10	S0128_032_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	033	0		29	10	S0128_033_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	033	0		29	10	S0128_033_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	033	0		29	10	S0128_033_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													16.09	25		25					19.85	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	033	0		29	10	S0128_033_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													72.57	40		40					89.76	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	033	0		29	10	S0128_033_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	034	0		29	10	S0128_034_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.20	6.00		18.00					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	034	0		29	10	S0128_034_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	034	0		29	10	S0128_034_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													16.49	25		25					20.33	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	034	0		29	10	S0128_034_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	034	0		29	10	S0128_034_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													74.86	40		40					92.52	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	035	0		29	10	S0128_035_0	6	1	Preferred Generic	1	2	001010	1	2		110	01	110		1				30		90	2	30		90				30		31									0.00	0.00		0.00					0.03	1.00		3.00					0.03	1.00		3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	035	0		29	10	S0128_035_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01	110		1				30		90	2	30		90				30		31									0.06	2.00		6.00					0.16	5.00		15.00					0.16	5.00		15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	035	0		29	10	S0128_035_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01	110		1				30		90	2	30		90				30		31													60.23	40		40					74.41	40		40					40		40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	035	0		29	10	S0128_035_0	6	3	Preferred Brand	1	2	000101	1	1		110	01	110		1				30		90	2	30		90				30		31													13.31	25		25					16.39	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0128	035	0		29	10	S0128_035_0	6	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0197	005	0		29	10	S0197_005_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0197	005	0		29	10	S0197_005_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0197	005	0		29	10	S0197_005_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					55.17	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0197	005	0		29	10	S0197_005_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					159.21	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S0197	005	0		29	10	S0197_005_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0197	005	0		29	10	S0197_005_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S0197	005	0		29	10	S0197_005_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					263.65	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S0197	005	0		29	10	S0197_005_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					53.59	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0223	003	0		29	10	S0223_003_0	6	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0223	003	0		29	10	S0223_003_0	6	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	30		90				2			90				30		31	0.03	1.00		3.00																								2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0223	003	0		29	10	S0223_003_0	6	5	Specialty Tier	1	2	010010	1	1	010		01			1	30													30		31					396.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0223	003	0		29	10	S0223_003_0	6	4	Non-Preferred Brand	1	2	100000	1	1	110		01	100		1	30		90				2			90				30		31					95.00	50		50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0223	003	0		29	10	S0223_003_0	6	3	Preferred Brand	1	2	000001	1	1	110		01	100		1	30		90				2			90				30		31					50.00	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.46	14.00	28.00	42.00																					0.46	14.00	28.00	42.00																		14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.43	43.00	86.00	129.00																					1.43	43.00	86.00	129.00																		43.00				1.39	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	7	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	7	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	7	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	7	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.26	38.00	76.00	114.00					1.43	43.00	86.00	129.00					1.26	38.00	76.00	114.00																		43.00				1.39	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	7	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.26	38.00	76.00	114.00					1.43	43.00	86.00	129.00					1.26	38.00	76.00	114.00																		43.00				1.39	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.30	39.00	78.00	117.00					1.46	44.00	88.00	132.00					1.30	39.00	78.00	117.00																		44.00				1.42	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.26	38.00	76.00	114.00					1.43	43.00	86.00	129.00					1.26	38.00	76.00	114.00																		43.00				1.39	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.23	37.00	74.00	111.00					1.40	42.00	84.00	126.00					1.23	37.00	74.00	111.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.23	37.00	74.00	111.00					1.40	42.00	84.00	126.00					1.23	37.00	74.00	111.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.13	34.00	68.00	102.00					1.30	39.00	78.00	117.00					1.13	34.00	68.00	102.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.10	33.00	66.00	99.00					1.26	38.00	76.00	114.00					1.10	33.00	66.00	99.00																		38.00				1.22	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	80.00	120.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.23	37.00	74.00	111.00					1.40	42.00	84.00	126.00					1.23	37.00	74.00	111.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.13	34.00	68.00	102.00					1.30	39.00	78.00	117.00					1.13	34.00	68.00	102.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.00	30.00	60.00	90.00					1.16	35.00	70.00	105.00					1.00	30.00	60.00	90.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.96	29.00	58.00	87.00					1.13	34.00	68.00	102.00					0.96	29.00	58.00	87.00																		34.00				1.09	34.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.96	29.00	58.00	87.00					1.13	34.00	68.00	102.00					0.96	29.00	58.00	87.00																		34.00				1.10	34.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.20	36.00	72.00	108.00					1.36	41.00	82.00	123.00					1.20	36.00	72.00	108.00																		41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.16	35.00	70.00	105.00					1.33	40.00	80.00	120.00					1.16	35.00	70.00	105.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				0.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.26	38.00	76.00	114.00					1.43	43.00	86.00	129.00					1.26	38.00	76.00	114.00																		43.00				1.39	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.46	14.00	28.00	42.00																					0.46	14.00	28.00	42.00																		14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.36	11.00	22.00	33.00																					0.36	11.00	22.00	33.00																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.43	43.00	86.00	129.00																					1.43	43.00	86.00	129.00																		43.00				1.39	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.43	13.00	26.00	39.00																					0.43	13.00	26.00	39.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.40	42.00	84.00	126.00																					1.40	42.00	84.00	126.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.46	14.00	28.00	42.00																					0.46	14.00	28.00	42.00																		14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.43	43.00	86.00	129.00																					1.43	43.00	86.00	129.00																		43.00				1.39	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.46	14.00	28.00	42.00																					0.46	14.00	28.00	42.00																		14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.43	43.00	86.00	129.00																					1.43	43.00	86.00	129.00																		43.00				1.39	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.46	44.00	88.00	132.00																					1.46	44.00	88.00	132.00																		44.00				1.42	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.46	14.00	28.00	42.00																					0.46	14.00	28.00	42.00																		14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.46	14.00	28.00	42.00																					0.46	14.00	28.00	42.00																		14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.40	12.00	24.00	36.00																					0.40	12.00	24.00	36.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.33	40.00	80.00	120.00																					1.33	40.00	80.00	120.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.46	14.00	28.00	42.00																					0.46	14.00	28.00	42.00																		14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	3	5	Specialty Tier	1	2	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31													1.00	25	25	25					1.00	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	3	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00					2.83	85.00	170.00	255.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	3	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									1.03	31.00	62.00	93.00					1.20	36.00	72.00	108.00					1.03	31.00	62.00	93.00																		36.00				1.16	36.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.03	1.00	2.00	3.00					0.06	2.00	4.00	6.00					0.03	1.00	2.00	3.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	3	2	Non-Preferred Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31									0.33	10.00	20.00	30.00					0.43	13.00	26.00	39.00					0.33	10.00	20.00	30.00																		13.00				.42	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.50	15.00	30.00	45.00																					0.50	15.00	30.00	45.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.46	44.00	88.00	132.00																					1.46	44.00	88.00	132.00																		44.00				1.42	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					1.00	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.83	85.00	170.00	255.00																					2.83	85.00	170.00	255.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	3.00																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.33	10.00	20.00	30.00																					0.33	10.00	20.00	30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.20	36.00	72.00	108.00																					1.20	36.00	72.00	108.00																		36.00				1.16	36.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3	5	Specialty Tier	1	4	010010	1	1		110	01	110		1				30		90	1	30		90				30		31														33		33						33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									2.16	65.00		130.00					2.16	65.00		195.00					2.16	65.00		130.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.33	40.00		80.00					1.33	40.00		120.00					1.33	40.00		80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.26	8.00		16.00					.26	8.00		24.00					.26	8.00		16.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.06	2.00		4.00					.06	2.00		6.00					.06	2.00		4.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	3	4	Non-Preferred Brand	1	2	110000	1	2		110	01	110		1				30		90	1	30		90				30		31									2.83	85.00		170.00					2.83	85.00		255.00					2.83	85.00		170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	3	5	Specialty Tier	1	2	010010	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	25		25					1.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	3	3	Preferred Brand	1	2	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.16	35.00		70.00					1.16	35.00		105.00					1.16	35.00		70.00																		35.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.26	8.00		16.00					.26	8.00		24.00					.26	8.00		16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	3	1	Preferred Generic	1	2	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									.13	4.00		8.00					.13	4.00		12.00					.13	4.00		8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1140	001	0		29	10	S1140_001_0	1	1	Preferred Generic	1	2	001000	1	2	110		10	110		1	30		90				2	30		90					29	31	0.16	5.00		10.00																					0.16	5.00		10.00																			5.00			0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1140	001	0		29	10	S1140_001_0	1	2	Non-Preferred Generic	1	2	000100	1	2	110		10	110		1	30		90				2	30		90					29	31	.52	16.00		32.00																					0.52	16.00		32.00																			16.00			.52	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1140	001	0		29	10	S1140_001_0	1	3	Preferred Brand	1	2	000001	1	2	110		10	110		1	30		90				2	30		90					29	31	1.42	44.00		88.00																					1.42	44.00		88.00																			44.00			1.42	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1140	001	0		29	10	S1140_001_0	1	4	Non-Preferred Brand	1	2	100000	1	2	110		10	110		1	30		90				2	30		90					29	31	2.87	89.00		178.00																					2.87	89.00		178.00																			89.00			2.87	89.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1140	001	0		29	10	S1140_001_0	1	5	Specialty Tier	1	2	010010	1	1	110		10	110		1	30		90				2	30		90					29	31					1.00	25		25																					25		25																		25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2321	002	0		29	10	S2321_002_0	2	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2321	002	0		29	10	S2321_002_0	2	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2321	002	0		29	10	S2321_002_0	2	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.00	30.00		90.00																								60.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2321	002	0		29	10	S2321_002_0	2	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.16	65.00		195.00																								130.00																		65.00				2.09	65.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2321	002	0		29	10	S2321_002_0	2	5	Specialty Tier	1	4	101101	1	1	110		01	100		1	30		90				1			90				30		31					394.68	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2321	002	0		29	10	S2321_002_0	2	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S2321	002	0		29	10	S2321_002_0	2	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S2321	005	0		29	10	S2321_005_0	2	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.16	5.00		15.00																								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2321	005	0		29	10	S2321_005_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2321	005	0		29	10	S2321_005_0	2	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2321	005	0		29	10	S2321_005_0	2	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.83	85.00		255.00																								170.00																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2321	005	0		29	10	S2321_005_0	2	5	Specialty Tier	1	3	101101	1	1	110		01	100		1	30		90				1			90				30		31					348.33	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	4	1	Preferred Generic	1	2	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.00	0.00		0.00								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	4	2	Non-Preferred Generic	1	2	001100	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		10.00					0.16	5.00		15.00								10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	4	3	Preferred Brand	1	2	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.50	45.00		90.00					1.50	45.00		135.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	4	4	Non-Preferred Brand	1	2	100100	1	2		110	01	100		1				30		90	1			90				30		31									3.00	90.00		180.00					3.00	90.00		270.00								180.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	4	5	Injectable Drugs	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													177.00	25		25					177.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	4	6	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													614.00	25		25					614.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.06	2.00		4.00					0.06	2.00		6.00								4.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	6	2	Non-Preferred Generic	1	4	001100	1	2		110	01	100		1				30		90	1			90				30		31									0.20	6.00		12.00					0.20	6.00		18.00								12.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	6	3	Preferred Brand	1	4	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.33	40.00		80.00					1.33	40.00		120.00								80.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	6	4	Non-Preferred Brand	1	4	100100	1	2		110	01	100		1				30		90	1			90				30		31									2.93	88.00		176.00					2.93	88.00		264.00								176.00																		88.00				2.84	88.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	6	5	Injectable Drugs	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													162.00	25		25					162.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	6	6	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1475.00	33		33					1475.00	33		33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2505	001	0		29	10	S2505_001_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00	180.00	270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	001	0		29	10	S2505_001_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					400.44	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	001	0		29	10	S2505_001_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.40	42.00	84.00	126.00																					1.40	42.00	84.00	126.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	001	0		29	10	S2505_001_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.30	9.00	18.00	27.00																					.30	9.00	18.00	27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	001	0		29	10	S2505_001_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00	180.00	270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.30	9.00	18.00	27.00																					.30	9.00	18.00	27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.43	43.00	86.00	129.00																					1.43	43.00	86.00	129.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					438.52	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	005	0		29	10	S2505_005_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00	180.00	270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	005	0		29	10	S2505_005_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					412.28	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	005	0		29	10	S2505_005_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.43	43.00	86.00	129.00																					1.43	43.00	86.00	129.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	005	0		29	10	S2505_005_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.30	9.00	18.00	27.00																					.30	9.00	18.00	27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	005	0		29	10	S2505_005_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					380.98	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.33	10.00	20.00	30.00																					.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.43	43.00	86.00	129.00																					1.43	43.00	86.00	129.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00	180.00	270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	009	0		29	10	S2505_009_0	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.30	9.00	18.00	27.00																					.30	9.00	18.00	27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	009	0		29	10	S2505_009_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					396.70	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	009	0		29	10	S2505_009_0	1	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00	180.00	270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	009	0		29	10	S2505_009_0	1	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	009	0		29	10	S2505_009_0	1	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	010	0		29	10	S2505_010_0	1	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	010	0		29	10	S2505_010_0	1	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.30	9.00	18.00	27.00																					.30	9.00	18.00	27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	010	0		29	10	S2505_010_0	1	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					399.34	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	010	0		29	10	S2505_010_0	1	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00	180.00	270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	010	0		29	10	S2505_010_0	1	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.50	45.00	90.00	135.00																					1.50	45.00	90.00	135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.43	43.00		129.00					1.50	45.00		135.00												1.43	43.00		119.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.43	43.00		129.00					1.50	45.00		135.00												1.43	43.00		119.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S2874	001	0		29	10	S2874_001_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S2874	004	0		29	10	S2874_004_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.23	7.00		21.00												0.03	1.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	5	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.40	12.00		36.00												0.06	2.00		0.00				0.40	12.00		36.00				12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													31.00	35		35					49.00	49		49												35		35					49		49			49				49	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	5	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	1	1	Preferred Generic	1	3	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.13	4.00		12.00								1.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	1	4	Non-Preferred Brand	1	3	100100	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		255.00					3.16	95.00		285.00								170.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	1	3	Preferred Brand	1	3	000101	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		105.00					1.50	45.00		135.00								70.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	1	2	Non-Preferred Generic	1	3	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.20	6.00		18.00					0.40	12.00		36.00								12.00																		12.00				0.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	1	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		31													484.34	27							483.86	27							27																			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	1	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								4.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S2893	003	0		29	10	S2893_003_0	1	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.30	9.00		27.00																								18.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S2893	003	0		29	10	S2893_003_0	1	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.13	4.00		12.00																								4.00																		4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	1	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.30	9.00		27.00																								18.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	1	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.00	30.00		90.00																								60.00																		30.00				0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	1	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	2.33	70.00		210.00																								140.00																		70.00				2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	1	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					526.01	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S3440	004	0		29	10	S3440_004_0	6	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	.16	5.00		12.50																								12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S3440	004	0		29	10	S3440_004_0	6	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	.55	17.00		42.50																								42.50																		17.00				.55	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S3440	004	0		29	10	S3440_004_0	6	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		31	1.45	45.00		112.50																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S3440	004	0		29	10	S3440_004_0	6	4	Non-Preferred Brand	1	3	100000	1	1	110		01	100		1	30		90				1			90				30		31					66.91	31		31																							31																	31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S3440	004	0		29	10	S3440_004_0	6	5	Specialty Tier	1	3	000010	1	1	110		01	100		1	30		90				1			90				30		31					709.64	31		31																							31																	31				31	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S3521	001	0		29	10	S3521_001_0	4	1	Preferred Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31									0.00	0.00		0.00					0.22	7.00		17.50												0.00	0.00		0.00				0.22	7.00		17.50				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S3521	001	0		29	10	S3521_001_0	4	2	Non-Preferred Generic	1	2	000100	1	2		110	01		110	1				30		90	1				30		90	30		31									0.22	7.00		17.50					0.45	14.00		35.00												0.22	7.00		17.50				0.45	14.00		35.00				14.00				0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S3521	001	0		29	10	S3521_001_0	4	3	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31													43.00	20		20					57.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S3521	001	0		29	10	S3521_001_0	4	4	Non-Preferred Brand	1	2	100000	1	1		110	01		110	1				30		90	1				30		90	30		31													81.00	35		35					94.00	40		40												35		35					40		40			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S4219	001	0		29	10	S4219_001_0	1	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.17	95.00		190.00					3.17	95.00		285.00					3.17	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4219	001	0		29	10	S4219_001_0	1	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4219	001	0		29	10	S4219_001_0	1	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									1.10	33.00		66.00					1.10	33.00		99.00					1.10	33.00		99.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4219	001	0		29	10	S4219_001_0	1	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									0.00	0.00		0.00					.05	1.50		4.50					.05	1.50		4.50																		1.50				.05	1.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4219	001	0		29	10	S4219_001_0	1	5	Specialty Tier	1	4	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	33		33					1.00	33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4219	003	0		29	10	S4219_003_0	1	1	Preferred Generic	1	2	001000	1	2		110	01	110		1				30		90	1	30		90				30		31									0.00	0.00		0.00					.07	2.00		6.00					.07	2.00		6.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4219	003	0		29	10	S4219_003_0	1	2	Non-Preferred Generic	1	2	000100	1	2		110	01	110		1				30		90	1	30		90				30		31									.27	8.00		16.00					.27	8.00		24.00					.27	8.00		24.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4219	003	0		29	10	S4219_003_0	1	3	Preferred Brand	1	2	000001	1	2		110	01	110		1				30		90	1	30		90				30		31									1.50	45.00		90.00					1.50	45.00		135.00					1.50	45.00		135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4219	003	0		29	10	S4219_003_0	1	4	Non-Preferred Brand	1	2	100000	1	2		110	01	110		1				30		90	1	30		90				30		31									3.17	95.00		190.00					3.17	95.00		285.00					3.17	95.00		285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4219	003	0		29	10	S4219_003_0	1	5	Specialty Tier	1	2	100000	1	1		110	01	110		1				30		90	1	30		90				30		31													1.00	25		25					1.00	25		25					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					442.02	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00	180.00	270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.43	43.00	86.00	129.00																					1.43	43.00	86.00	129.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.30	9.00	18.00	27.00																					.30	9.00	18.00	27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.43	43.00	86.00	129.00																					1.43	43.00	86.00	129.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.33	10.00	20.00	30.00																					.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					409.05	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00	180.00	270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.43	43.00	86.00	129.00																					1.43	43.00	86.00	129.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.30	9.00	18.00	27.00																					.30	9.00	18.00	27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					403.79	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					371.82	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	90.00	180.00	270.00																					3.00	90.00	180.00	270.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.43	43.00	86.00	129.00																					1.43	43.00	86.00	129.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.33	10.00	20.00	30.00																					.33	10.00	20.00	30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	3	4	Non-Preferred Brand	1	2	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.16	95.00	190.00	285.00																					3.16	95.00	190.00	285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	3	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.43	43.00	86.00	129.00																					1.43	43.00	86.00	129.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	3	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.36	11.00	22.00	33.00																					.36	11.00	22.00	33.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	3	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	.10	3.00	6.00	9.00																					.10	3.00	6.00	9.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	3	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31					369.14	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	5	5	Specialty Tier	1	3	101101	1	1		111	01		111	1				30	60	90	2				30	60	90	30		31													1.00	29	29	29					1.00	29	29	29												29	29	29					29	29	29			29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									2.83	85.00	170.00	255.00					3.16	95.00	190.00	285.00												2.83	85.00	170.00	212.50				3.16	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	5	3	Preferred Brand	1	3	000001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00												1.33	40.00	80.00	100.00				1.50	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.33	10.00	20.00	30.00					1.10	33.00	66.00	99.00												0.33	10.00	20.00	25.00				1.10	33.00	66.00	99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.13	4.00	8.00	12.00					0.33	10.00	20.00	30.00												0.13	4.00	0.00	0.00				0.33	10.00	20.00	30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	4	5	Specialty Tier	1	4	101101	1	1		111	01		111	1				30	60	90	2				30	60	90	30		31													1.00	33	33	33					1.00	33	33	33												33	33	33					33	33	33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	4	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									2.33	70.00	140.00	210.00					3.16	95.00	190.00	285.00												2.33	70.00	140.00	175.00				3.16	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									1.00	30.00	60.00	90.00					1.50	45.00	90.00	135.00												1.00	30.00	60.00	75.00				1.50	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.20	6.00	12.00	18.00					0.66	20.00	40.00	60.00												.20	6.00	12.00	15.00				.66	20.00	40.00	60.00				20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	4	1	Preferred Generic	3	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.10	3.00	6.00	9.00					0.26	8.00	16.00	24.00												0.10	3.00	0.00	0.00				0.26	8.00	16.00	24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5540	004	0		29	10	S5540_004_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31									0.10	3.00	6.00	9.00					0.26	8.00	16.00	24.00												0.10	3.00	0.00	0.00				0.26	8.00	16.00	24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	4	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5552	003	0		29	10	S5552_003_0	4	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5552	003	0		29	10	S5552_003_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	4	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	6	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													39.00	35		35					52.00	43		43												35		35					43		43			43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	6	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	20		20					29.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	6	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.13	4.00		12.00												0.06	2.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	6	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	7	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	7	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	7	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	20		20					28.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	7	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													35.00	39		39					47.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	7	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5569	006	0		29	10	S5569_006_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5569	006	0		29	10	S5569_006_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5569	006	0		29	10	S5569_006_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5569	006	0		29	10	S5569_006_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5569	006	0		29	10	S5569_006_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5569	007	0		29	10	S5569_007_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5569	007	0		29	10	S5569_007_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													34.45	14	14	14					35.16	15	15	15					14	14	14																	15				15	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5569	007	0		29	10	S5569_007_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													30.31	40	40	40					30.54	41	41	41					40	40	40																	41				41	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5580	003	0		29	10	S5580_003_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	003	0		29	10	S5580_003_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	003	0		29	10	S5580_003_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	003	0		29	10	S5580_003_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	003	0		29	10	S5580_003_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	006	0		29	10	S5580_006_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		111.00					1.50	45.00		135.00								122.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	006	0		29	10	S5580_006_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	006	0		29	10	S5580_006_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	006	0		29	10	S5580_006_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	006	0		29	10	S5580_006_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	6	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				31				31						31		31													1.00	25							1.00	25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	6	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.06	95.00		237.50					3.06	95.00		285.00					3.06	95.00		237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	6	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.45	45.00		112.50					1.45	45.00		135.00					1.45	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	6	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.13	4.00		10.00					.13	4.00		12.00					.13	4.00		10.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	6	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.48	15.00		37.50					.48	15.00		45.00					.48	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													1.00	33							1.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.74	85.00		212.50					2.74	85.00		255.00					2.74	85.00		212.50																		85.00				2.74	85.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.45	45.00		112.50					1.45	45.00		135.00					1.45	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	7	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.16	5.00		12.50					.16	5.00		15.00					.16	5.00		12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.06	2.00		5.00					.06	2.00		6.00					.06	2.00		5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.06	2.00		5.00					.06	2.00		6.00					.06	2.00		5.00																		2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5593	002	0		29	10	S5593_002_0	5	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5	5	Specialty Tier	1	2	010010	1	1	110		01	100		1	31		90				1			90				31		31					775.17	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5	4	Non-Preferred Brand	1	2	100000	1	1	110		01	100		1	31		90				1			90				31		31					91.52	50		50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5	3	Preferred Brand	1	2	000001	1	1	110		01	100		1	31		90				1			90				31		31					47.09	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.35	11.00		33.00																								27.50																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	.22	7.00		21.00																								17.50																		7.00				.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.25	70.00		210.00																								175.00																		70.00				2.25	70.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1050.36	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	1	Generic	3	4	010000	1	1	110		01	100		1	31		90				1			90				31		31					16.77	50		50																							50																	50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5593	007	0		29	10	S5593_007_0	5	5	Specialty Tier	1	2	010010	1	1	110		01	100		1	31		90				1			90				31		31					775.17	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	007	0		29	10	S5593_007_0	5	4	Non-Preferred Brand	1	2	100000	1	1	110		01	100		1	31		90				1			90				31		31					91.52	50		50																							50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	007	0		29	10	S5593_007_0	5	3	Preferred Brand	1	2	000001	1	1	110		01	100		1	31		90				1			90				31		31					47.09	25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	007	0		29	10	S5593_007_0	5	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	31		90				1			90				31		31	0.35	11.00		33.00																								27.50																		11.00				0.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	007	0		29	10	S5593_007_0	5	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.00	0.00		0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	008	0		29	10	S5593_008_0	5	1	Generic	1	4	010000	1	2	110		01	100		1	31		90				1			90				31		31	.22	7.00		21.00																								17.50																		7.00				.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	008	0		29	10	S5593_008_0	5	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.29	40.00		120.00																								100.00																		40.00				1.29	40.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	008	0		29	10	S5593_008_0	5	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				1			90				31		31	2.25	70.00		210.00																								175.00																		70.00				2.25	70.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	008	0		29	10	S5593_008_0	5	4	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		90				1			90				31		31					1050.36	33		33																							33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	008	0		29	10	S5593_008_0	5	1	Generic	3	4	010000	1	1	110		01	100		1	31		90				1			90				31		31					16.77	50		50																							50																	50				50	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5596	001	0		29	10	S5596_001_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	001	0		29	10	S5596_001_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	4	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													63.74	33	33	33					63.74	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	003	0		29	10	S5596_003_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	003	0		29	10	S5596_003_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	003	0		29	10	S5596_003_0	4	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	003	0		29	10	S5596_003_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	003	0		29	10	S5596_003_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	003	0		29	10	S5596_003_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	003	0		29	10	S5596_003_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	003	0		29	10	S5596_003_0	4	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	003	0		29	10	S5596_003_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													103.43	68	68	68					104.95	69	69	69					69	69	69																	69				69	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	1	
S5596	005	0		29	10	S5596_005_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.30	9.00	18.00	27.00					0.56	17.00	34.00	51.00					0.30	9.00	18.00	18.00																		17.00				0.50	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	4	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													70.35	33	33	33					70.35	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	006	0		29	10	S5596_006_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	007	0		29	10	S5596_007_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	007	0		29	10	S5596_007_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													105.63	68	68	68					107.18	69	69	69					69	69	69																	69				69	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	1	
S5596	007	0		29	10	S5596_007_0	4	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	007	0		29	10	S5596_007_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	007	0		29	10	S5596_007_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	007	0		29	10	S5596_007_0	4	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	007	0		29	10	S5596_007_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	007	0		29	10	S5596_007_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	007	0		29	10	S5596_007_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.90	87.00	174.00	261.00					3.06	92.00	184.00	276.00					2.90	87.00	261.00	261.00																		92.00				2.70	92.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.23	37.00	74.00	111.00					1.40	42.00	84.00	126.00					1.23	37.00	111.00	111.00																		42.00				1.23	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.43	13.00	26.00	39.00					0.16	5.00	10.00	10.00																		13.00				0.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													82.73	25	25	25					82.73	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	4	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													60.65	33	33	33					60.65	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	010	0		29	10	S5596_010_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	011	0		29	10	S5596_011_0	4	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	011	0		29	10	S5596_011_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	011	0		29	10	S5596_011_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	011	0		29	10	S5596_011_0	4	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	011	0		29	10	S5596_011_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													99.72	68	68	68					101.19	69	69	69					69	69	69																	69				69	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	1	
S5596	011	0		29	10	S5596_011_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	011	0		29	10	S5596_011_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	011	0		29	10	S5596_011_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	011	0		29	10	S5596_011_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.93	88.00	176.00	264.00					3.10	93.00	186.00	279.00					2.93	88.00	264.00	264.00																		93.00				2.73	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.43	13.00	26.00	39.00					0.16	5.00	10.00	10.00																		13.00				0.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.30	39.00	78.00	117.00					1.46	44.00	88.00	132.00					1.30	39.00	117.00	117.00																		44.00				1.29	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	3	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	3	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	014	0		29	10	S5596_014_0	3	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	3	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													72.44	33	33	33					72.44	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	3	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	015	0		29	10	S5596_015_0	3	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	015	0		29	10	S5596_015_0	3	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	015	0		29	10	S5596_015_0	3	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	015	0		29	10	S5596_015_0	3	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	015	0		29	10	S5596_015_0	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	015	0		29	10	S5596_015_0	3	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	015	0		29	10	S5596_015_0	3	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	015	0		29	10	S5596_015_0	3	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													100.22	68	68	68					101.69	69	69	69					69	69	69																	69				69	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	1	
S5596	015	0		29	10	S5596_015_0	3	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.96	89.00	178.00	267.00					3.13	94.00	188.00	282.00					2.96	89.00	267.00	267.00																		94.00				2.76	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.20	36.00	72.00	108.00					1.36	41.00	82.00	123.00					1.20	36.00	108.00	108.00																		41.00				1.20	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.43	13.00	26.00	39.00					0.16	5.00	10.00	10.00																		13.00				0.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	018	0		29	10	S5596_018_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	4	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													60.10	33	33	33					60.10	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	019	0		29	10	S5596_019_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	019	0		29	10	S5596_019_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	019	0		29	10	S5596_019_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	019	0		29	10	S5596_019_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	019	0		29	10	S5596_019_0	4	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	019	0		29	10	S5596_019_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													105.33	68	68	68					106.88	69	69	69					69	69	69																	69				69	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	1	
S5596	019	0		29	10	S5596_019_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	019	0		29	10	S5596_019_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	019	0		29	10	S5596_019_0	4	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													90.03	33	33	33					90.03	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	4	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	4	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.90	87.00	174.00	261.00					3.06	92.00	184.00	276.00					2.90	87.00	261.00	261.00																		92.00				2.70	92.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	4	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.16	35.00	70.00	105.00					1.33	40.00	80.00	120.00					1.16	35.00	105.00	105.00																		40.00				1.17	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.20	6.00	12.00	18.00					0.46	14.00	28.00	42.00					0.20	6.00	12.00	12.00																		14.00				0.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	4	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													68.90	33	33	33					68.90	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	034	0		29	10	S5596_034_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	035	0		29	10	S5596_035_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	035	0		29	10	S5596_035_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	035	0		29	10	S5596_035_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	035	0		29	10	S5596_035_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	035	0		29	10	S5596_035_0	4	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	035	0		29	10	S5596_035_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	035	0		29	10	S5596_035_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	035	0		29	10	S5596_035_0	4	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	035	0		29	10	S5596_035_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													97.88	68	68	68					99.32	69	69	69					69	69	69																	69				69	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	1	
S5596	043	0		29	10	S5596_043_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.43	13.00	26.00	39.00					0.16	5.00	10.00	10.00																		13.00				0.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.86	86.00	172.00	258.00					3.03	91.00	182.00	273.00					2.86	86.00	258.00	258.00																		91.00				2.67	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.13	34.00	68.00	102.00					1.30	39.00	78.00	117.00					1.13	34.00	102.00	102.00																		39.00				1.14	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	044	0		29	10	S5596_044_0	4	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													64.97	33	33	33					64.97	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	045	0		29	10	S5596_045_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	045	0		29	10	S5596_045_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	045	0		29	10	S5596_045_0	4	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	045	0		29	10	S5596_045_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													100.95	68	68	68					102.44	69	69	69					69	69	69																	69				69	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	1	
S5596	045	0		29	10	S5596_045_0	4	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	045	0		29	10	S5596_045_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	045	0		29	10	S5596_045_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	045	0		29	10	S5596_045_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	045	0		29	10	S5596_045_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.96	89.00	178.00	267.00					3.13	94.00	188.00	282.00					2.96	89.00	267.00	267.00																		94.00				2.76	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													85.80	25	25	25					85.80	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.90	87.00	174.00	261.00					3.06	92.00	184.00	276.00					2.90	87.00	261.00	261.00																		92.00				2.70	92.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.26	38.00	76.00	114.00					1.43	43.00	86.00	129.00					1.26	38.00	114.00	114.00																		43.00				1.26	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.13	4.00	8.00	12.00					0.40	12.00	24.00	36.00					0.13	4.00	8.00	8.00																		12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	4	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													68.01	33	33	33					68.01	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	057	0		29	10	S5596_057_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	058	0		29	10	S5596_058_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	058	0		29	10	S5596_058_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													105.48	68	68	68					107.03	69	69	69					69	69	69																	69				69	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	1	
S5596	058	0		29	10	S5596_058_0	4	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	058	0		29	10	S5596_058_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	058	0		29	10	S5596_058_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	058	0		29	10	S5596_058_0	4	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	058	0		29	10	S5596_058_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	058	0		29	10	S5596_058_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	058	0		29	10	S5596_058_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.93	88.00	176.00	264.00					3.10	93.00	186.00	279.00					2.93	88.00	264.00	264.00																		93.00				2.73	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.23	37.00	74.00	111.00					1.40	42.00	84.00	126.00					1.23	37.00	111.00	111.00																		42.00				1.23	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	060	0		29	10	S5596_060_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	4	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													73.03	33	33	33					73.03	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	061	0		29	10	S5596_061_0	4	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	061	0		29	10	S5596_061_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	061	0		29	10	S5596_061_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	061	0		29	10	S5596_061_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													90.62	68	68	68					91.95	69	69	69					69	69	69																	69				69	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	1	
S5596	061	0		29	10	S5596_061_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	061	0		29	10	S5596_061_0	4	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	061	0		29	10	S5596_061_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	061	0		29	10	S5596_061_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	061	0		29	10	S5596_061_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.20	6.00	12.00	18.00					0.46	14.00	28.00	42.00					0.20	6.00	12.00	12.00																		14.00				0.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.30	39.00	78.00	117.00					1.46	44.00	88.00	132.00					1.30	39.00	117.00	117.00																		44.00				1.29	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	063	0		29	10	S5596_063_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	4	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													70.61	33	33	33					70.61	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	064	0		29	10	S5596_064_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	064	0		29	10	S5596_064_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	064	0		29	10	S5596_064_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	064	0		29	10	S5596_064_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	064	0		29	10	S5596_064_0	4	5	Injectable Drugs	1	4	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	064	0		29	10	S5596_064_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5596	064	0		29	10	S5596_064_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													102.51	68	68	68					104.02	69	69	69					69	69	69																	69				69	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	1	
S5596	064	0		29	10	S5596_064_0	4	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5596	064	0		29	10	S5596_064_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5601	002	0		29	10	S5601_002_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					17.38	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					64.75	40	40	40																					40	40	40																	40				40	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					417.86	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	003	0		29	10	S5601_003_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	003	0		29	10	S5601_003_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													515.91	33	33	33					515.91	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	3	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					17.73	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	3	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					405.81	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	3	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					63.38	40	40	40																					40	40	40																	40				40	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	3	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	3	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													498.05	33	33	33					498.05	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	3	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	005	0		29	10	S5601_005_0	3	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	005	0		29	10	S5601_005_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					20.28	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					400.33	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					66.00	40	40	40																					40	40	40																	40				40	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													523.17	33	33	33					523.17	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	007	0		29	10	S5601_007_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	007	0		29	10	S5601_007_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					18.85	19	19	19																					19	19	19																	19				19	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					69.07	40	40	40																					40	40	40																	40				40	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					413.53	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													546.74	33	33	33					546.74	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	009	0		29	10	S5601_009_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	010	0		29	10	S5601_010_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					18.40	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					66.81	42	42	42																					42	42	42																	42				42	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					387.89	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													448.97	33	33	33					448.97	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	011	0		29	10	S5601_011_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	012	0		29	10	S5601_012_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					406.90	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					63.68	43	43	43																					43	43	43																	43				43	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					19.41	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	013	0		29	10	S5601_013_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													464.98	33	33	33					464.98	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	013	0		29	10	S5601_013_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					401.66	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					63.75	43	43	43																					43	43	43																	43				43	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					19.15	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													455.71	33	33	33					455.71	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	015	0		29	10	S5601_015_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	015	0		29	10	S5601_015_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					20.70	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					415.95	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					70.09	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.71	33	33	33					489.71	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	017	0		29	10	S5601_017_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	017	0		29	10	S5601_017_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					433.02	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					67.93	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					20.25	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	019	0		29	10	S5601_019_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	019	0		29	10	S5601_019_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													516.33	33	33	33					516.33	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					396.71	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					22.14	21	21	21																					21	21	21																	21				21	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					60.92	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													527.94	33	33	33					527.94	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	021	0		29	10	S5601_021_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	021	0		29	10	S5601_021_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					403.06	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					20.48	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					67.13	41	41	41																					41	41	41																	41				41	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	023	0		29	10	S5601_023_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	023	0		29	10	S5601_023_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													521.14	33	33	33					521.14	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					61.19	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					426.70	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					21.10	21	21	21																					21	21	21																	21				21	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	025	0		29	10	S5601_025_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	025	0		29	10	S5601_025_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													520.43	33	33	33					520.43	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					19.60	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					67.68	41	41	41																					41	41	41																	41				41	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					448.13	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	027	0		29	10	S5601_027_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	027	0		29	10	S5601_027_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													470.59	33	33	33					470.59	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					410.79	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					18.74	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					69.02	43	43	43																					43	43	43																	43				43	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													518.69	33	33	33					518.69	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	029	0		29	10	S5601_029_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	030	0		29	10	S5601_030_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					20.21	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					70.08	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					418.35	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	031	0		29	10	S5601_031_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													493.57	33	33	33					493.57	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	031	0		29	10	S5601_031_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					64.82	40	40	40																					40	40	40																	40				40	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					17.67	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					417.59	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	033	0		29	10	S5601_033_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	033	0		29	10	S5601_033_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													417.74	33	33	33					417.74	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					19.73	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					429.40	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					68.28	44	44	44																					44	44	44																	44				44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													518.83	33	33	33					518.83	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	035	0		29	10	S5601_035_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	036	0		29	10	S5601_036_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					69.47	42	42	42																					42	42	42																	42				42	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					19.58	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					439.85	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													555.57	33	33	33					555.57	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	037	0		29	10	S5601_037_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	038	0		29	10	S5601_038_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					63.02	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					21.37	21	21	21																					21	21	21																	21				21	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					448.53	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					62.16	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					449.83	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					22.10	21	21	21																					21	21	21																	21				21	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													534.70	33	33	33					534.70	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	041	0		29	10	S5601_041_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	041	0		29	10	S5601_041_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					421.02	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					21.23	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					66.59	44	44	44																					44	44	44																	44				44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					23.72	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					69.89	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					422.14	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	045	0		29	10	S5601_045_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	045	0		29	10	S5601_045_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													563.78	33	33	33					563.78	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					446.38	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					20.45	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					71.14	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					69.21	44	44	44																					44	44	44																	44				44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					18.79	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					436.28	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	049	0		29	10	S5601_049_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													506.60	33	33	33					506.60	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	049	0		29	10	S5601_049_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					417.33	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					66.73	41	41	41																					41	41	41																	41				41	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					17.52	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													470.76	33	33	33					470.76	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	051	0		29	10	S5601_051_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	052	0		29	10	S5601_052_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					452.72	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					66.39	45	45	45																					45	45	45																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					18.30	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	053	0		29	10	S5601_053_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	053	0		29	10	S5601_053_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													551.22	33	33	33					551.22	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					414.44	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					71.20	44	44	44																					44	44	44																	44				44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					19.06	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	055	0		29	10	S5601_055_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	055	0		29	10	S5601_055_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													475.21	33	33	33					475.21	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					420.77	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					17.02	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					54.04	41	41	41																					41	41	41																	41				41	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													563.66	33	33	33					563.66	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	057	0		29	10	S5601_057_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	058	0		29	10	S5601_058_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					18.69	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					59.73	41	41	41																					41	41	41																	41				41	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					409.46	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													493.31	33	33	33					493.31	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	059	0		29	10	S5601_059_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	060	0		29	10	S5601_060_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					427.64	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					17.09	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					68.04	42	42	42																					42	42	42																	42				42	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													458.46	33	33	33					458.46	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	061	0		29	10	S5601_061_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	061	0		29	10	S5601_061_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					18.29	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					66.77	40	40	40																					40	40	40																	40				40	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					441.04	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	063	0		29	10	S5601_063_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													609.06	33	33	33					609.06	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	063	0		29	10	S5601_063_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					64.13	40	40	40																					40	40	40																	40				40	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					20.54	20	20	20																					20	20	20																	20				20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					418.23	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	065	0		29	10	S5601_065_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	065	0		29	10	S5601_065_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													556.52	33	33	33					556.52	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					437.06	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					73.52	40	40	40																					40	40	40																	40				40	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					20.83	19	19	19																					19	19	19																	19				19	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	067	0		29	10	S5601_067_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	067	0		29	10	S5601_067_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													598.48	33	33	33					598.48	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	2	3	Non-Preferred Brand	1	2	100100	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					51.04	39	39	39																					39	39	39																	39				39	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	2	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		34					397.39	25	25	25																					25	25	25																	25				25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	2	1	Generic	1	2	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	.07	2.00	4.00	5.00																					.07	2.00	4.00	5.00																		2.00				.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	2	2	Preferred Brand	1	2	000101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		34					14.39	19	19	19																					19	19	19																	19				19	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	107	0		29	10	S5601_107_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													616.19	33	33	33					616.19	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	107	0		29	10	S5601_107_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													553.68	33	33	33					553.68	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	108	0		29	10	S5601_108_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	109	0		29	10	S5601_109_0	2	2	Preferred Brand	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	109	0		29	10	S5601_109_0	2	3	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.37	41.00	82.00	102.50					1.60	48.00	96.00	144.00					1.37	41.00	82.00	102.50																		48.00				1.41	48.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	2	1	Generic	3	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	109	0		29	10	S5601_109_0	2	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													543.61	33	33	33					543.61	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	2	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				0.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	2	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.57	17.00	34.00	42.50					0.80	24.00	48.00	72.00					0.57	17.00	34.00	42.50																		24.00				0.71	24.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	110	0		29	10	S5601_110_0	4	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	110	0		29	10	S5601_110_0	4	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	110	0		29	10	S5601_110_0	4	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	110	0		29	10	S5601_110_0	4	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	111	0		29	10	S5601_111_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	111	0		29	10	S5601_111_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	111	0		29	10	S5601_111_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	111	0		29	10	S5601_111_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	112	0		29	10	S5601_112_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	112	0		29	10	S5601_112_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	112	0		29	10	S5601_112_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	112	0		29	10	S5601_112_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	113	0		29	10	S5601_113_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	113	0		29	10	S5601_113_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	113	0		29	10	S5601_113_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	113	0		29	10	S5601_113_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	114	0		29	10	S5601_114_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	114	0		29	10	S5601_114_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	114	0		29	10	S5601_114_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	114	0		29	10	S5601_114_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	115	0		29	10	S5601_115_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	115	0		29	10	S5601_115_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	115	0		29	10	S5601_115_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	115	0		29	10	S5601_115_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	116	0		29	10	S5601_116_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	116	0		29	10	S5601_116_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	116	0		29	10	S5601_116_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	116	0		29	10	S5601_116_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	117	0		29	10	S5601_117_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	117	0		29	10	S5601_117_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	117	0		29	10	S5601_117_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	117	0		29	10	S5601_117_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	118	0		29	10	S5601_118_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	118	0		29	10	S5601_118_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	118	0		29	10	S5601_118_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	118	0		29	10	S5601_118_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	119	0		29	10	S5601_119_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	119	0		29	10	S5601_119_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	119	0		29	10	S5601_119_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	119	0		29	10	S5601_119_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	120	0		29	10	S5601_120_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	120	0		29	10	S5601_120_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	120	0		29	10	S5601_120_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	120	0		29	10	S5601_120_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	121	0		29	10	S5601_121_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	121	0		29	10	S5601_121_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	121	0		29	10	S5601_121_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	121	0		29	10	S5601_121_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	122	0		29	10	S5601_122_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	122	0		29	10	S5601_122_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	122	0		29	10	S5601_122_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	122	0		29	10	S5601_122_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	123	0		29	10	S5601_123_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	123	0		29	10	S5601_123_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	123	0		29	10	S5601_123_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	123	0		29	10	S5601_123_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	124	0		29	10	S5601_124_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	124	0		29	10	S5601_124_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	124	0		29	10	S5601_124_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	124	0		29	10	S5601_124_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	125	0		29	10	S5601_125_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	125	0		29	10	S5601_125_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	125	0		29	10	S5601_125_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	125	0		29	10	S5601_125_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	126	0		29	10	S5601_126_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	126	0		29	10	S5601_126_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	126	0		29	10	S5601_126_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	126	0		29	10	S5601_126_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	127	0		29	10	S5601_127_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	127	0		29	10	S5601_127_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	127	0		29	10	S5601_127_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	127	0		29	10	S5601_127_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	128	0		29	10	S5601_128_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	128	0		29	10	S5601_128_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	128	0		29	10	S5601_128_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	128	0		29	10	S5601_128_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	129	0		29	10	S5601_129_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	129	0		29	10	S5601_129_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	129	0		29	10	S5601_129_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	129	0		29	10	S5601_129_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	130	0		29	10	S5601_130_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	130	0		29	10	S5601_130_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	130	0		29	10	S5601_130_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	130	0		29	10	S5601_130_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	131	0		29	10	S5601_131_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	131	0		29	10	S5601_131_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	131	0		29	10	S5601_131_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	131	0		29	10	S5601_131_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	132	0		29	10	S5601_132_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	132	0		29	10	S5601_132_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	132	0		29	10	S5601_132_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	132	0		29	10	S5601_132_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	133	0		29	10	S5601_133_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	133	0		29	10	S5601_133_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	133	0		29	10	S5601_133_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	133	0		29	10	S5601_133_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	134	0		29	10	S5601_134_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	134	0		29	10	S5601_134_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	134	0		29	10	S5601_134_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	134	0		29	10	S5601_134_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	135	0		29	10	S5601_135_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	135	0		29	10	S5601_135_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	135	0		29	10	S5601_135_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	135	0		29	10	S5601_135_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	136	0		29	10	S5601_136_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	136	0		29	10	S5601_136_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	136	0		29	10	S5601_136_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	136	0		29	10	S5601_136_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	137	0		29	10	S5601_137_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	137	0		29	10	S5601_137_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	137	0		29	10	S5601_137_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	137	0		29	10	S5601_137_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	138	0		29	10	S5601_138_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	138	0		29	10	S5601_138_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	138	0		29	10	S5601_138_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	138	0		29	10	S5601_138_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	139	0		29	10	S5601_139_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	139	0		29	10	S5601_139_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	139	0		29	10	S5601_139_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	139	0		29	10	S5601_139_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	140	0		29	10	S5601_140_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	140	0		29	10	S5601_140_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	140	0		29	10	S5601_140_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	140	0		29	10	S5601_140_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	141	0		29	10	S5601_141_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	141	0		29	10	S5601_141_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	141	0		29	10	S5601_141_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	141	0		29	10	S5601_141_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	142	0		29	10	S5601_142_0	3	1	Generic	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.00	0.00	0.00	0.00					0.23	7.00	14.00	21.00					0.00	0.00	0.00	0.00																		7.00				.21	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	142	0		29	10	S5601_142_0	3	2	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	60.00					1.03	31.00	62.00	93.00					0.80	24.00	48.00	60.00																		31.00				0.91	31.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	142	0		29	10	S5601_142_0	3	4	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	2	30	60	90				30		34													489.72	33	33	33					489.72	33	33	33					33	33	33																	33				33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	142	0		29	10	S5601_142_0	3	3	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													46.70	35	35	35					60.04	45	45	45					35	35	35																	45				45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	4	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					500.00	27																							27																			27				27	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	4	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	4	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	4	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.23	7.00		21.00																					0.23	7.00		14.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					566.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.33	40.00		120.00																					1.33	40.00		100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5609	002	0		29	10	S5609_002_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	4	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.10	3.00		7.50					1.06	32.00		96.00												0.10	3.00		0.00				1.06	32.00		96.00					32.00			1.03	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	4	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.00	30.00		75.00					1.43	43.00		129.00												1.00	30.00		65.00				1.43	43.00		129.00					43.00			1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	4	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.16	65.00		162.50					3.16	95.00		285.00												2.16	65.00		152.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	4	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.96	89.00		222.50					3.16	95.00		285.00												2.96	89.00		212.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	5	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	5	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.16	65.00		162.50					2.66	80.00		240.00												2.16	65.00		152.50				2.66	80.00		240.00					80.00			2.58	80.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	5	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	5	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.10	3.00		7.50					1.06	32.00		96.00												0.10	3.00		0.00				1.06	32.00		96.00					32.00			1.03	32.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	5	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.00	30.00		75.00					1.16	35.00		105.00												1.00	30.00		65.00				1.16	35.00		105.00					35.00			1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.50	45.00		112.50					1.50	45.00		135.00												1.50	45.00		102.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.30	9.00		22.50					1.10	33.00		99.00												0.30	9.00		12.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									3.00	90.00		225.00					3.16	95.00		285.00												3.00	90.00		215.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.30	9.00		22.50					1.10	33.00		99.00												0.30	9.00		12.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.43	43.00		107.50					1.50	45.00		135.00												1.43	43.00		97.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									3.03	91.00		227.50					3.16	95.00		285.00												3.03	91.00		217.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									3.00	90.00		225.00					3.16	95.00		285.00												3.00	90.00		215.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.33	40.00		100.00					1.50	45.00		135.00												1.33	40.00		90.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.30	9.00		22.50					1.10	33.00		99.00												0.30	9.00		12.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.20	6.00		15.00					0.83	25.00		75.00												0.20	6.00		5.00				0.83	25.00		75.00					25.00			0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.00	30.00		75.00					1.43	43.00		129.00												1.00	30.00		65.00				1.43	43.00		129.00					43.00			1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.50	75.00		187.50					3.03	91.00		273.00												2.50	75.00		177.50				3.03	91.00		273.00					91.00			2.93	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.73	82.00		205.00					3.16	95.00		285.00												2.73	82.00		195.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.20	6.00		15.00					1.10	33.00		99.00												0.20	6.00		5.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.20	36.00		90.00					1.50	45.00		135.00												1.20	36.00		80.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.93	88.00		220.00					3.16	95.00		285.00												2.93	88.00		210.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.10	3.00		7.50					1.10	33.00		99.00												0.10	3.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.06	32.00		80.00					1.50	45.00		135.00												1.06	32.00		70.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.73	82.00		205.00					3.16	95.00		285.00												2.73	82.00		195.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.10	3.00		7.50					1.00	30.00		90.00												0.10	3.00		0.00				1.00	30.00		90.00					30.00			0.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.06	32.00		80.00					1.33	40.00		120.00												1.06	32.00		70.00				1.33	40.00		120.00					40.00			1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.16	65.00		162.50					2.90	87.00		261.00												2.16	65.00		152.50				2.90	87.00		261.00					87.00			2.80	87.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.20	66.00		165.00					2.70	81.00		243.00												2.20	66.00		155.00				2.70	81.00		243.00					81.00			2.61	81.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.20	36.00		90.00					1.33	40.00		120.00												1.20	36.00		80.00				1.33	40.00		120.00					40.00			1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.10	3.00		7.50					0.76	23.00		69.00												0.10	3.00		0.00				0.76	23.00		69.00					23.00			0.74	23.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.30	9.00		22.50					1.10	33.00		99.00												0.30	9.00		12.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.06	32.00		80.00					1.50	45.00		135.00												1.06	32.00		70.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.76	83.00		207.50					3.16	95.00		285.00												2.76	83.00		197.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.30	9.00		22.50					1.10	33.00		99.00												0.30	9.00		12.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.20	36.00		90.00					1.50	45.00		135.00												1.20	36.00		80.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.83	85.00		212.50					3.16	95.00		285.00												2.83	85.00		202.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.96	89.00		222.50					3.16	95.00		285.00												2.96	89.00		212.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.30	9.00		22.50					1.10	33.00		99.00												0.30	9.00		12.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.30	9.00		22.50					1.10	33.00		99.00												0.30	9.00		12.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									3.00	90.00		225.00					3.16	95.00		285.00												3.00	90.00		215.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.46	44.00		110.00					1.50	45.00		135.00												1.46	44.00		100.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.20	6.00		15.00					1.10	33.00		99.00												0.20	6.00		5.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.33	70.00		175.00					3.16	95.00		285.00												2.33	70.00		165.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.16	35.00		87.50					1.50	45.00		135.00												1.16	35.00		77.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.63	79.00		197.50					3.16	95.00		285.00												2.63	79.00		187.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.20	36.00		90.00					1.50	45.00		135.00												1.20	36.00		80.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.40	42.00		105.00					1.50	45.00		135.00												1.40	42.00		95.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.30	9.00		22.50					1.10	33.00		99.00												0.30	9.00		12.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									3.00	90.00		225.00					3.16	95.00		285.00												3.00	90.00		215.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									3.00	90.00		225.00					3.16	95.00		285.00												3.00	90.00		215.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.33	40.00		100.00					1.50	45.00		135.00												1.33	40.00		90.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.30	9.00		22.50					1.10	33.00		99.00												0.30	9.00		12.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	172	0		29	10	S5617_172_0	4	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	172	0		29	10	S5617_172_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	172	0		29	10	S5617_172_0	4	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	172	0		29	10	S5617_172_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	172	0		29	10	S5617_172_0	4	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	172	0		29	10	S5617_172_0	4	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	172	0		29	10	S5617_172_0	4	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	172	0		29	10	S5617_172_0	4	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	172	0		29	10	S5617_172_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	176	0		29	10	S5617_176_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	176	0		29	10	S5617_176_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	176	0		29	10	S5617_176_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	176	0		29	10	S5617_176_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	176	0		29	10	S5617_176_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	176	0		29	10	S5617_176_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	176	0		29	10	S5617_176_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	176	0		29	10	S5617_176_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	176	0		29	10	S5617_176_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	177	0		29	10	S5617_177_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	177	0		29	10	S5617_177_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	177	0		29	10	S5617_177_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	177	0		29	10	S5617_177_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	177	0		29	10	S5617_177_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	177	0		29	10	S5617_177_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	177	0		29	10	S5617_177_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	177	0		29	10	S5617_177_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	177	0		29	10	S5617_177_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	178	0		29	10	S5617_178_0	4	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	178	0		29	10	S5617_178_0	4	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	178	0		29	10	S5617_178_0	4	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	178	0		29	10	S5617_178_0	4	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	178	0		29	10	S5617_178_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	178	0		29	10	S5617_178_0	4	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	178	0		29	10	S5617_178_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	178	0		29	10	S5617_178_0	4	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	178	0		29	10	S5617_178_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	179	0		29	10	S5617_179_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	179	0		29	10	S5617_179_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	179	0		29	10	S5617_179_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	179	0		29	10	S5617_179_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	179	0		29	10	S5617_179_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	179	0		29	10	S5617_179_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	179	0		29	10	S5617_179_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	179	0		29	10	S5617_179_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	179	0		29	10	S5617_179_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	181	0		29	10	S5617_181_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	181	0		29	10	S5617_181_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	181	0		29	10	S5617_181_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	181	0		29	10	S5617_181_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	181	0		29	10	S5617_181_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	181	0		29	10	S5617_181_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	181	0		29	10	S5617_181_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	181	0		29	10	S5617_181_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	181	0		29	10	S5617_181_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	182	0		29	10	S5617_182_0	4	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	182	0		29	10	S5617_182_0	4	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	182	0		29	10	S5617_182_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	182	0		29	10	S5617_182_0	4	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	182	0		29	10	S5617_182_0	4	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	182	0		29	10	S5617_182_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	182	0		29	10	S5617_182_0	4	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	182	0		29	10	S5617_182_0	4	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	182	0		29	10	S5617_182_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	183	0		29	10	S5617_183_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	183	0		29	10	S5617_183_0	4	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	183	0		29	10	S5617_183_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	183	0		29	10	S5617_183_0	4	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	183	0		29	10	S5617_183_0	4	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	183	0		29	10	S5617_183_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	183	0		29	10	S5617_183_0	4	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	183	0		29	10	S5617_183_0	4	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	183	0		29	10	S5617_183_0	4	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	184	0		29	10	S5617_184_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	184	0		29	10	S5617_184_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	184	0		29	10	S5617_184_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	184	0		29	10	S5617_184_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	184	0		29	10	S5617_184_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	184	0		29	10	S5617_184_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	184	0		29	10	S5617_184_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	184	0		29	10	S5617_184_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	184	0		29	10	S5617_184_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	185	0		29	10	S5617_185_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	185	0		29	10	S5617_185_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	185	0		29	10	S5617_185_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	185	0		29	10	S5617_185_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	185	0		29	10	S5617_185_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	185	0		29	10	S5617_185_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	185	0		29	10	S5617_185_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	185	0		29	10	S5617_185_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	185	0		29	10	S5617_185_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	187	0		29	10	S5617_187_0	4	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	187	0		29	10	S5617_187_0	4	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	187	0		29	10	S5617_187_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	187	0		29	10	S5617_187_0	4	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	187	0		29	10	S5617_187_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	187	0		29	10	S5617_187_0	4	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	187	0		29	10	S5617_187_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	187	0		29	10	S5617_187_0	4	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	187	0		29	10	S5617_187_0	4	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	188	0		29	10	S5617_188_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	188	0		29	10	S5617_188_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	188	0		29	10	S5617_188_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	188	0		29	10	S5617_188_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	188	0		29	10	S5617_188_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	188	0		29	10	S5617_188_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	188	0		29	10	S5617_188_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	188	0		29	10	S5617_188_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	188	0		29	10	S5617_188_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	189	0		29	10	S5617_189_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	189	0		29	10	S5617_189_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	189	0		29	10	S5617_189_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	189	0		29	10	S5617_189_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	189	0		29	10	S5617_189_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	189	0		29	10	S5617_189_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	189	0		29	10	S5617_189_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	189	0		29	10	S5617_189_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	189	0		29	10	S5617_189_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	192	0		29	10	S5617_192_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	192	0		29	10	S5617_192_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	192	0		29	10	S5617_192_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	192	0		29	10	S5617_192_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	192	0		29	10	S5617_192_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	192	0		29	10	S5617_192_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	192	0		29	10	S5617_192_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	192	0		29	10	S5617_192_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	192	0		29	10	S5617_192_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	195	0		29	10	S5617_195_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	195	0		29	10	S5617_195_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	195	0		29	10	S5617_195_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	195	0		29	10	S5617_195_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	195	0		29	10	S5617_195_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	195	0		29	10	S5617_195_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	195	0		29	10	S5617_195_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	195	0		29	10	S5617_195_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	195	0		29	10	S5617_195_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	198	0		29	10	S5617_198_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	198	0		29	10	S5617_198_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	198	0		29	10	S5617_198_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	198	0		29	10	S5617_198_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	198	0		29	10	S5617_198_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	198	0		29	10	S5617_198_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	198	0		29	10	S5617_198_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	198	0		29	10	S5617_198_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	198	0		29	10	S5617_198_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	214	0		29	10	S5617_214_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.83	85.00		212.50					3.16	95.00		285.00												2.83	85.00		202.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.16	35.00		87.50					1.50	45.00		135.00												1.16	35.00		77.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.96	29.00		72.50					1.50	45.00		135.00												0.96	29.00		62.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.10	63.00		157.50					3.16	95.00		285.00												2.10	63.00		147.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	216	0		29	10	S5617_216_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.06	62.00		155.00					3.16	95.00		285.00												2.06	62.00		145.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	216	0		29	10	S5617_216_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.96	29.00		72.50					1.50	45.00		135.00												0.96	29.00		62.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	216	0		29	10	S5617_216_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	216	0		29	10	S5617_216_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	216	0		29	10	S5617_216_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.10	3.00		7.50					1.10	33.00		99.00												0.10	3.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.96	29.00		72.50					1.50	45.00		135.00												0.96	29.00		62.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.16	65.00		162.50					2.90	87.00		261.00												2.16	65.00		152.50				2.90	87.00		261.00					87.00			2.80	87.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.86	86.00		215.00					3.16	95.00		285.00												2.86	86.00		205.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.10	3.00		7.50					1.10	33.00		99.00												0.10	3.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.83	85.00		212.50					3.16	95.00		285.00												2.83	85.00		202.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.03	31.00		77.50					1.50	45.00		135.00												1.03	31.00		67.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.10	3.00		7.50					1.10	33.00		99.00												0.10	3.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.03	31.00		77.50					1.46	44.00		132.00												1.03	31.00		67.50				1.46	44.00		132.00					44.00			1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									1.96	59.00		147.50					3.03	91.00		273.00												1.96	59.00		137.50				3.03	91.00		273.00					91.00			2.93	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.16	65.00		162.50					2.33	70.00		210.00												2.16	65.00		152.50				2.33	70.00		210.00					70.00			2.25	70.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.10	3.00		7.50					0.86	26.00		78.00												0.10	3.00		0.00				0.86	26.00		78.00					26.00			0.83	26.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.00	30.00		75.00					1.16	35.00		105.00												1.00	30.00		65.00				1.16	35.00		105.00					35.00			1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.76	83.00		207.50					2.80	84.00		252.00												2.76	83.00		197.50				2.80	84.00		252.00					84.00			2.70	84.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.00	30.00		75.00					1.43	43.00		129.00												1.00	30.00		65.00				1.43	43.00		129.00					43.00			1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.10	3.00		7.50					0.90	27.00		81.00												0.10	3.00		0.00				0.90	27.00		81.00					27.00			0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.16	65.00		162.50					2.76	83.00		249.00												2.16	65.00		152.50				2.76	83.00		249.00					83.00			2.67	83.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.10	3.00		7.50					0.63	19.00		57.00												0.10	3.00		0.00				0.63	19.00		57.00					19.00			0.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.00	30.00		75.00					1.16	35.00		105.00												1.00	30.00		65.00				1.16	35.00		105.00					35.00			1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.16	65.00		162.50					2.90	87.00		261.00												2.16	65.00		152.50				2.90	87.00		261.00					87.00			2.80	87.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.00	30.00		75.00					1.33	40.00		120.00												1.00	30.00		65.00				1.33	40.00		120.00					40.00			1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.10	3.00		7.50					0.90	27.00		81.00												0.10	3.00		0.00				0.90	27.00		81.00					27.00			0.87	27.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.23	67.00		167.50					3.16	95.00		285.00												2.23	67.00		157.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.06	32.00		80.00					1.50	45.00		135.00												1.06	32.00		70.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.16	65.00		162.50					2.73	82.00		246.00												2.16	65.00		152.50				2.73	82.00		246.00					82.00			2.64	82.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.00	30.00		75.00					1.33	40.00		120.00												1.00	30.00		65.00				1.33	40.00		120.00					40.00			1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.10	3.00		7.50					0.83	25.00		75.00												0.10	3.00		0.00				0.83	25.00		75.00					25.00			0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	3	5	Specialty Tier	1	2	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														25		25						25		25												25		25					25		25				25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.80	84.00		210.00					3.16	95.00		285.00												2.80	84.00		200.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	3	1	Preferred Generic	1	2	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	3	2	Non-Preferred Generic	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.20	6.00		15.00					1.10	33.00		99.00												0.20	6.00		5.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	3	3	Preferred Brand	1	2	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.10	33.00		82.50					1.50	45.00		135.00												1.10	33.00		72.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	228	0		29	10	S5617_228_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	228	0		29	10	S5617_228_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	228	0		29	10	S5617_228_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	228	0		29	10	S5617_228_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	228	0		29	10	S5617_228_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	228	0		29	10	S5617_228_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	228	0		29	10	S5617_228_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	228	0		29	10	S5617_228_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	228	0		29	10	S5617_228_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	229	0		29	10	S5617_229_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	229	0		29	10	S5617_229_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	229	0		29	10	S5617_229_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	229	0		29	10	S5617_229_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	229	0		29	10	S5617_229_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	229	0		29	10	S5617_229_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	229	0		29	10	S5617_229_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	229	0		29	10	S5617_229_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	229	0		29	10	S5617_229_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	230	0		29	10	S5617_230_0	2	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	230	0		29	10	S5617_230_0	2	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	230	0		29	10	S5617_230_0	2	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	230	0		29	10	S5617_230_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	230	0		29	10	S5617_230_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	230	0		29	10	S5617_230_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	230	0		29	10	S5617_230_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	230	0		29	10	S5617_230_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	230	0		29	10	S5617_230_0	2	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	231	0		29	10	S5617_231_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	231	0		29	10	S5617_231_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	231	0		29	10	S5617_231_0	2	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	231	0		29	10	S5617_231_0	2	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	231	0		29	10	S5617_231_0	2	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	231	0		29	10	S5617_231_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	231	0		29	10	S5617_231_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	231	0		29	10	S5617_231_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	231	0		29	10	S5617_231_0	2	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	232	0		29	10	S5617_232_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	232	0		29	10	S5617_232_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	232	0		29	10	S5617_232_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	232	0		29	10	S5617_232_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	232	0		29	10	S5617_232_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	232	0		29	10	S5617_232_0	2	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	232	0		29	10	S5617_232_0	2	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	232	0		29	10	S5617_232_0	2	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	232	0		29	10	S5617_232_0	2	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	233	0		29	10	S5617_233_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	233	0		29	10	S5617_233_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	233	0		29	10	S5617_233_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	233	0		29	10	S5617_233_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	233	0		29	10	S5617_233_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	233	0		29	10	S5617_233_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	233	0		29	10	S5617_233_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	233	0		29	10	S5617_233_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	233	0		29	10	S5617_233_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	234	0		29	10	S5617_234_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	234	0		29	10	S5617_234_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	234	0		29	10	S5617_234_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	234	0		29	10	S5617_234_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	234	0		29	10	S5617_234_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	234	0		29	10	S5617_234_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	234	0		29	10	S5617_234_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	234	0		29	10	S5617_234_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	234	0		29	10	S5617_234_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	235	0		29	10	S5617_235_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	235	0		29	10	S5617_235_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	235	0		29	10	S5617_235_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	235	0		29	10	S5617_235_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	235	0		29	10	S5617_235_0	2	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	235	0		29	10	S5617_235_0	2	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	235	0		29	10	S5617_235_0	2	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	235	0		29	10	S5617_235_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	235	0		29	10	S5617_235_0	2	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	236	0		29	10	S5617_236_0	2	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	236	0		29	10	S5617_236_0	2	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	236	0		29	10	S5617_236_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	236	0		29	10	S5617_236_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	236	0		29	10	S5617_236_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	236	0		29	10	S5617_236_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	236	0		29	10	S5617_236_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	236	0		29	10	S5617_236_0	2	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	236	0		29	10	S5617_236_0	2	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	237	0		29	10	S5617_237_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	237	0		29	10	S5617_237_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	237	0		29	10	S5617_237_0	3	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	237	0		29	10	S5617_237_0	3	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	237	0		29	10	S5617_237_0	3	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	237	0		29	10	S5617_237_0	3	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	237	0		29	10	S5617_237_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	237	0		29	10	S5617_237_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.36	71.00		177.50					3.16	95.00		285.00												2.36	71.00		167.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	237	0		29	10	S5617_237_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.73	22.00		55.00					1.50	45.00		135.00												0.73	22.00		45.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	238	0		29	10	S5617_238_0	2	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	238	0		29	10	S5617_238_0	2	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	238	0		29	10	S5617_238_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	238	0		29	10	S5617_238_0	2	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	238	0		29	10	S5617_238_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	238	0		29	10	S5617_238_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	238	0		29	10	S5617_238_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	238	0		29	10	S5617_238_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	238	0		29	10	S5617_238_0	2	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	239	0		29	10	S5617_239_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	239	0		29	10	S5617_239_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	239	0		29	10	S5617_239_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	239	0		29	10	S5617_239_0	2	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	239	0		29	10	S5617_239_0	2	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	239	0		29	10	S5617_239_0	2	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	239	0		29	10	S5617_239_0	2	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	239	0		29	10	S5617_239_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	239	0		29	10	S5617_239_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	240	0		29	10	S5617_240_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	240	0		29	10	S5617_240_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	240	0		29	10	S5617_240_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	240	0		29	10	S5617_240_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	240	0		29	10	S5617_240_0	2	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	240	0		29	10	S5617_240_0	2	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	240	0		29	10	S5617_240_0	2	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	240	0		29	10	S5617_240_0	2	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	240	0		29	10	S5617_240_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	241	0		29	10	S5617_241_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	241	0		29	10	S5617_241_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	241	0		29	10	S5617_241_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	241	0		29	10	S5617_241_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	241	0		29	10	S5617_241_0	2	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	241	0		29	10	S5617_241_0	2	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	241	0		29	10	S5617_241_0	2	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	241	0		29	10	S5617_241_0	2	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	241	0		29	10	S5617_241_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	242	0		29	10	S5617_242_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	242	0		29	10	S5617_242_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	242	0		29	10	S5617_242_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	242	0		29	10	S5617_242_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	242	0		29	10	S5617_242_0	2	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	242	0		29	10	S5617_242_0	2	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	242	0		29	10	S5617_242_0	2	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	242	0		29	10	S5617_242_0	2	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	242	0		29	10	S5617_242_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	243	0		29	10	S5617_243_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	243	0		29	10	S5617_243_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	243	0		29	10	S5617_243_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	243	0		29	10	S5617_243_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	243	0		29	10	S5617_243_0	2	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	243	0		29	10	S5617_243_0	2	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	243	0		29	10	S5617_243_0	2	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	243	0		29	10	S5617_243_0	2	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	243	0		29	10	S5617_243_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	244	0		29	10	S5617_244_0	2	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	244	0		29	10	S5617_244_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	244	0		29	10	S5617_244_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	244	0		29	10	S5617_244_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	244	0		29	10	S5617_244_0	2	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	244	0		29	10	S5617_244_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	244	0		29	10	S5617_244_0	2	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	244	0		29	10	S5617_244_0	2	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	244	0		29	10	S5617_244_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	245	0		29	10	S5617_245_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	245	0		29	10	S5617_245_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	245	0		29	10	S5617_245_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	245	0		29	10	S5617_245_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	245	0		29	10	S5617_245_0	2	4	Non-Preferred Brand	3	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.46	74.00		185.00					3.16	95.00		285.00												2.46	74.00		175.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	245	0		29	10	S5617_245_0	2	1	Preferred Generic	3	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	245	0		29	10	S5617_245_0	2	2	Non-Preferred Generic	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.13	4.00		10.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5617	245	0		29	10	S5617_245_0	2	3	Preferred Brand	3	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.83	25.00		62.50					1.50	45.00		135.00												0.83	25.00		52.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5617	245	0		29	10	S5617_245_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.16	35.00		87.50					1.50	45.00		135.00												1.16	35.00		77.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.80	84.00		210.00					3.16	95.00		285.00												2.80	84.00		200.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	248	0		29	10	S5617_248_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	248	0		29	10	S5617_248_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	248	0		29	10	S5617_248_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	248	0		29	10	S5617_248_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.80	84.00		210.00					3.16	95.00		285.00												2.80	84.00		200.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	248	0		29	10	S5617_248_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.16	35.00		87.50					1.50	45.00		135.00												1.16	35.00		77.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	253	0		29	10	S5617_253_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	253	0		29	10	S5617_253_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	253	0		29	10	S5617_253_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.16	35.00		87.50					1.50	45.00		135.00												1.16	35.00		77.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	253	0		29	10	S5617_253_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	253	0		29	10	S5617_253_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.80	84.00		210.00					3.16	95.00		285.00												2.80	84.00		200.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	257	0		29	10	S5617_257_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	257	0		29	10	S5617_257_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	257	0		29	10	S5617_257_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.16	35.00		87.50					1.50	45.00		135.00												1.16	35.00		77.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	257	0		29	10	S5617_257_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.80	84.00		210.00					3.16	95.00		285.00												2.80	84.00		200.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	257	0		29	10	S5617_257_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	258	0		29	10	S5617_258_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.80	84.00		210.00					3.16	95.00		285.00												2.80	84.00		200.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	258	0		29	10	S5617_258_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.16	35.00		87.50					1.50	45.00		135.00												1.16	35.00		77.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	258	0		29	10	S5617_258_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	258	0		29	10	S5617_258_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	258	0		29	10	S5617_258_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	261	0		29	10	S5617_261_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.80	84.00		210.00					3.16	95.00		285.00												2.80	84.00		200.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	261	0		29	10	S5617_261_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.16	35.00		87.50					1.50	45.00		135.00												1.16	35.00		77.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	261	0		29	10	S5617_261_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	261	0		29	10	S5617_261_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	261	0		29	10	S5617_261_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	262	0		29	10	S5617_262_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	262	0		29	10	S5617_262_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	262	0		29	10	S5617_262_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.16	35.00		87.50					1.50	45.00		135.00												1.16	35.00		77.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	262	0		29	10	S5617_262_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.80	84.00		210.00					3.16	95.00		285.00												2.80	84.00		200.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	262	0		29	10	S5617_262_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	265	0		29	10	S5617_265_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	265	0		29	10	S5617_265_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	265	0		29	10	S5617_265_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.16	35.00		87.50					1.50	45.00		135.00												1.16	35.00		77.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	265	0		29	10	S5617_265_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.80	84.00		210.00					3.16	95.00		285.00												2.80	84.00		200.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	265	0		29	10	S5617_265_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	269	0		29	10	S5617_269_0	3	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	269	0		29	10	S5617_269_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	269	0		29	10	S5617_269_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.80	84.00		210.00					3.16	95.00		285.00												2.80	84.00		200.00				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	269	0		29	10	S5617_269_0	3	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.16	35.00		87.50					1.50	45.00		135.00												1.16	35.00		77.50				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	269	0		29	10	S5617_269_0	3	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	2	1	Preferred Generic	1	4	001001	1	2		110	10		110	1				30		90	1				30		90		10	31									0.00	0.00		0.00					0.33	10.00		30.00												0.00	0.00		0.00				0.33	10.00		30.00					10.00			0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	2	2	Non-Preferred Generic	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									0.16	5.00		12.50					1.10	33.00		99.00												0.16	5.00		2.50				1.10	33.00		99.00					33.00			1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	10		110	1				30		90	1				30		90		10	31									2.90	87.00		217.50					3.16	95.00		285.00												2.90	87.00		207.50				3.16	95.00		285.00					95.00			3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	2	3	Preferred Brand	1	4	000101	1	2		110	10		110	1				30		90	1				30		90		10	31									1.26	38.00		95.00					1.50	45.00		135.00												1.26	38.00		85.00				1.50	45.00		135.00					45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	2	5	Specialty Tier	1	4	010010	1	1		110	10		110	1				30		90	1				30		90		10	31														33		33						33		33												33		33					33		33				33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					83.14	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					45.79	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.25	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.25	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					48.43	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					77.55	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					87.15	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					46.99	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					48.47	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					85.35	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					47.13	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					78.50	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.25	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					73.30	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					44.53	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					47.06	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					82.01	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					81.54	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					46.66	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.19	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					46.48	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					72.17	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					48.31	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					83.32	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					71.45	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					47.41	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.19	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					50.77	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					77.88	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					47.50	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					84.85	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					47.61	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					77.81	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.25	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					50.24	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					96.09	45		45																														45							45			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					85.84	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					43.76	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					45.38	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					75.87	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					46.99	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					71.30	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.19	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					74.15	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					44.21	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.19	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					72.02	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					46.93	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.19	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.25	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					41.54	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					73.78	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					72.41	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					48.40	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					48.56	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					82.17	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					44.94	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					75.19	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.25	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					41.49	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					52.23	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.25	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					75.72	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					44.92	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					78.46	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					43.65	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					45.52	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					82.72	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.25	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					46.57	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					81.04	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					54.18	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.25	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					85.14	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					74.49	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					40.21	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					64.45	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					60.09	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.25	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					48.35	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					76.86	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.22	7.00		21.00																															14.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.25	8.00		24.00																															16.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					41.66	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					59.95	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.29	9.00		23.00					.51	16.00		40.00															18.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.29	9.00		23.00					.51	16.00		40.00															18.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	3	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.29	9.00		23.00					.51	16.00		40.00															18.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.29	9.00		23.00					.51	16.00		40.00															18.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.29	9.00		23.00					.51	16.00		40.00															18.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	1	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.32	10.00		25.00					.51	16.00		40.00															20.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	1	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	030	0		29	10	S5670_030_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					47.40	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	030	0		29	10	S5670_030_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	030	0		29	10	S5670_030_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					144.98	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	030	0		29	10	S5670_030_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					227.16	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	030	0		29	10	S5670_030_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	030	0		29	10	S5670_030_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	030	0		29	10	S5670_030_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					47.01	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	030	0		29	10	S5670_030_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	036	0		29	10	S5670_036_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	036	0		29	10	S5670_036_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					220.70	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	036	0		29	10	S5670_036_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	036	0		29	10	S5670_036_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	036	0		29	10	S5670_036_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					41.00	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	036	0		29	10	S5670_036_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					47.22	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	036	0		29	10	S5670_036_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	036	0		29	10	S5670_036_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					124.45	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	042	0		29	10	S5670_042_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					46.65	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	042	0		29	10	S5670_042_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	042	0		29	10	S5670_042_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	042	0		29	10	S5670_042_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					38.68	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	042	0		29	10	S5670_042_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					122.06	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	042	0		29	10	S5670_042_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					224.37	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	042	0		29	10	S5670_042_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	042	0		29	10	S5670_042_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	048	0		29	10	S5670_048_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	048	0		29	10	S5670_048_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	048	0		29	10	S5670_048_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					119.41	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	048	0		29	10	S5670_048_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					241.63	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	048	0		29	10	S5670_048_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	048	0		29	10	S5670_048_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	048	0		29	10	S5670_048_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					39.70	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	048	0		29	10	S5670_048_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					49.18	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	054	0		29	10	S5670_054_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	054	0		29	10	S5670_054_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					44.98	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	054	0		29	10	S5670_054_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	054	0		29	10	S5670_054_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	054	0		29	10	S5670_054_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					225.89	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	054	0		29	10	S5670_054_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					47.03	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	054	0		29	10	S5670_054_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	054	0		29	10	S5670_054_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					138.12	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	060	0		29	10	S5670_060_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					238.22	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	060	0		29	10	S5670_060_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					119.42	44	44	44																					44	44	44																	44				44	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	060	0		29	10	S5670_060_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	060	0		29	10	S5670_060_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	060	0		29	10	S5670_060_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					50.19	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	060	0		29	10	S5670_060_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					40.13	44	44	44																					44	44	44																	44				44	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	060	0		29	10	S5670_060_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	060	0		29	10	S5670_060_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	066	0		29	10	S5670_066_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					234.63	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	066	0		29	10	S5670_066_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	066	0		29	10	S5670_066_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					123.12	44	44	44																					44	44	44																	44				44	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	066	0		29	10	S5670_066_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	066	0		29	10	S5670_066_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	066	0		29	10	S5670_066_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					48.15	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	066	0		29	10	S5670_066_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					40.48	44	44	44																					44	44	44																	44				44	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	066	0		29	10	S5670_066_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	072	0		29	10	S5670_072_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	072	0		29	10	S5670_072_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					225.48	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	072	0		29	10	S5670_072_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	072	0		29	10	S5670_072_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	072	0		29	10	S5670_072_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					42.75	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	072	0		29	10	S5670_072_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					46.38	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	072	0		29	10	S5670_072_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	072	0		29	10	S5670_072_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					137.91	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	078	0		29	10	S5670_078_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					221.98	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	078	0		29	10	S5670_078_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	078	0		29	10	S5670_078_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	078	0		29	10	S5670_078_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					39.98	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	078	0		29	10	S5670_078_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					46.82	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	078	0		29	10	S5670_078_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	078	0		29	10	S5670_078_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	078	0		29	10	S5670_078_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					120.50	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	084	0		29	10	S5670_084_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					46.35	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	084	0		29	10	S5670_084_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	084	0		29	10	S5670_084_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	084	0		29	10	S5670_084_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					42.29	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	084	0		29	10	S5670_084_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	084	0		29	10	S5670_084_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	084	0		29	10	S5670_084_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					222.56	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	084	0		29	10	S5670_084_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					133.51	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	090	0		29	10	S5670_090_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					45.96	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	090	0		29	10	S5670_090_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	090	0		29	10	S5670_090_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	090	0		29	10	S5670_090_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					41.57	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	090	0		29	10	S5670_090_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					125.50	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	090	0		29	10	S5670_090_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					211.47	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	090	0		29	10	S5670_090_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	090	0		29	10	S5670_090_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	096	0		29	10	S5670_096_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	096	0		29	10	S5670_096_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	096	0		29	10	S5670_096_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					45.95	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	096	0		29	10	S5670_096_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					226.43	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	096	0		29	10	S5670_096_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	096	0		29	10	S5670_096_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	096	0		29	10	S5670_096_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					38.13	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	096	0		29	10	S5670_096_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					122.71	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	102	0		29	10	S5670_102_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	102	0		29	10	S5670_102_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	102	0		29	10	S5670_102_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					46.58	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	102	0		29	10	S5670_102_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					39.11	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	102	0		29	10	S5670_102_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					121.62	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	102	0		29	10	S5670_102_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					223.25	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	102	0		29	10	S5670_102_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	102	0		29	10	S5670_102_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	108	0		29	10	S5670_108_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					106.05	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	108	0		29	10	S5670_108_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					215.33	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	108	0		29	10	S5670_108_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					35.69	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	108	0		29	10	S5670_108_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	108	0		29	10	S5670_108_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	108	0		29	10	S5670_108_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					45.61	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	108	0		29	10	S5670_108_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	108	0		29	10	S5670_108_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	114	0		29	10	S5670_114_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					40.98	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	114	0		29	10	S5670_114_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					47.16	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	114	0		29	10	S5670_114_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	114	0		29	10	S5670_114_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	114	0		29	10	S5670_114_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	114	0		29	10	S5670_114_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	114	0		29	10	S5670_114_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					222.73	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	114	0		29	10	S5670_114_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					127.21	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	120	0		29	10	S5670_120_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					236.44	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	120	0		29	10	S5670_120_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					116.02	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	120	0		29	10	S5670_120_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	120	0		29	10	S5670_120_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	120	0		29	10	S5670_120_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					49.88	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	120	0		29	10	S5670_120_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					41.32	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	120	0		29	10	S5670_120_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	120	0		29	10	S5670_120_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	126	0		29	10	S5670_126_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	126	0		29	10	S5670_126_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	126	0		29	10	S5670_126_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					45.81	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	126	0		29	10	S5670_126_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					126.06	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	126	0		29	10	S5670_126_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					216.59	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	126	0		29	10	S5670_126_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	126	0		29	10	S5670_126_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	126	0		29	10	S5670_126_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					42.09	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	132	0		29	10	S5670_132_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					128.08	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	132	0		29	10	S5670_132_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	132	0		29	10	S5670_132_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	132	0		29	10	S5670_132_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					255.10	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	132	0		29	10	S5670_132_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					41.83	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	132	0		29	10	S5670_132_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					54.74	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	132	0		29	10	S5670_132_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	132	0		29	10	S5670_132_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	138	0		29	10	S5670_138_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					130.20	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	138	0		29	10	S5670_138_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					352.83	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	138	0		29	10	S5670_138_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	138	0		29	10	S5670_138_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	138	0		29	10	S5670_138_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	138	0		29	10	S5670_138_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					66.21	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	138	0		29	10	S5670_138_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					43.71	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	138	0		29	10	S5670_138_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	144	0		29	10	S5670_144_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					123.11	44	44	44																					44	44	44																	44				44	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5670	144	0		29	10	S5670_144_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	144	0		29	10	S5670_144_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.16	5.00	10.00	15.00																					0.16	5.00	10.00	12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	144	0		29	10	S5670_144_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					269.29	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	144	0		29	10	S5670_144_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	144	0		29	10	S5670_144_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					53.84	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	144	0		29	10	S5670_144_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					40.12	42	42	42																					42	42	42																	42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	144	0		29	10	S5670_144_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	150	0		29	10	S5670_150_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					50.35	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	150	0		29	10	S5670_150_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	150	0		29	10	S5670_150_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	150	0		29	10	S5670_150_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					41.27	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	150	0		29	10	S5670_150_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5670	150	0		29	10	S5670_150_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5670	150	0		29	10	S5670_150_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					240.29	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5670	150	0		29	10	S5670_150_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					127.66	45	45	45																					45	45	45																	45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5674	005	0		29	10	S5674_005_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	005	0		29	10	S5674_005_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	005	0		29	10	S5674_005_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					133.59	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5674	005	0		29	10	S5674_005_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5674	005	0		29	10	S5674_005_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					217.40	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5674	005	0		29	10	S5674_005_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	005	0		29	10	S5674_005_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					40.60	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	005	0		29	10	S5674_005_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					43.90	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	011	0		29	10	S5674_011_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	011	0		29	10	S5674_011_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					42.49	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	011	0		29	10	S5674_011_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	011	0		29	10	S5674_011_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					48.80	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	011	0		29	10	S5674_011_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					137.82	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5674	011	0		29	10	S5674_011_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					237.26	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5674	011	0		29	10	S5674_011_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5674	011	0		29	10	S5674_011_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	017	0		29	10	S5674_017_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5674	017	0		29	10	S5674_017_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	017	0		29	10	S5674_017_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					43.45	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	017	0		29	10	S5674_017_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					50.06	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	017	0		29	10	S5674_017_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	017	0		29	10	S5674_017_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	017	0		29	10	S5674_017_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					238.21	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5674	017	0		29	10	S5674_017_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					134.74	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5674	023	0		29	10	S5674_023_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					43.08	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	023	0		29	10	S5674_023_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	023	0		29	10	S5674_023_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5674	023	0		29	10	S5674_023_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					231.21	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5674	023	0		29	10	S5674_023_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					126.73	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5674	023	0		29	10	S5674_023_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	023	0		29	10	S5674_023_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	023	0		29	10	S5674_023_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					49.44	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	029	0		29	10	S5674_029_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					114.90	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5674	029	0		29	10	S5674_029_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					231.49	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5674	029	0		29	10	S5674_029_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5674	029	0		29	10	S5674_029_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					37.32	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	029	0		29	10	S5674_029_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	029	0		29	10	S5674_029_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					48.16	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	029	0		29	10	S5674_029_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	029	0		29	10	S5674_029_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	035	0		29	10	S5674_035_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	035	0		29	10	S5674_035_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5674	035	0		29	10	S5674_035_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					220.83	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5674	035	0		29	10	S5674_035_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					117.78	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5674	035	0		29	10	S5674_035_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	035	0		29	10	S5674_035_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	035	0		29	10	S5674_035_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					45.59	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	035	0		29	10	S5674_035_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					37.07	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	041	0		29	10	S5674_041_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					53.06	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	041	0		29	10	S5674_041_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					41.38	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	041	0		29	10	S5674_041_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	041	0		29	10	S5674_041_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5674	041	0		29	10	S5674_041_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					272.54	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5674	041	0		29	10	S5674_041_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					129.96	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5674	041	0		29	10	S5674_041_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	041	0		29	10	S5674_041_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	047	0		29	10	S5674_047_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	047	0		29	10	S5674_047_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5674	047	0		29	10	S5674_047_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					221.51	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5674	047	0		29	10	S5674_047_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					124.63	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5674	047	0		29	10	S5674_047_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					45.39	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	047	0		29	10	S5674_047_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					40.30	41	41	41																					41	41	41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	047	0		29	10	S5674_047_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	047	0		29	10	S5674_047_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	053	0		29	10	S5674_053_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					216.57	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5674	053	0		29	10	S5674_053_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					127.38	40	40	40																					40	40	40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5674	053	0		29	10	S5674_053_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	053	0		29	10	S5674_053_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	053	0		29	10	S5674_053_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					45.31	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	053	0		29	10	S5674_053_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					38.49	40	40	40																					40	40	40																	40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	053	0		29	10	S5674_053_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	053	0		29	10	S5674_053_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5674	059	0		29	10	S5674_059_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					50.88	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	059	0		29	10	S5674_059_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	059	0		29	10	S5674_059_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	059	0		29	10	S5674_059_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					45.16	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	059	0		29	10	S5674_059_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	059	0		29	10	S5674_059_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.10	3.00	6.00	9.00																					0.10	3.00	6.00	7.50																		3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5674	059	0		29	10	S5674_059_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					238.41	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5674	059	0		29	10	S5674_059_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					136.01	43	43	43																					43	43	43																	43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5674	065	0		29	10	S5674_065_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					53.35	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	065	0		29	10	S5674_065_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	065	0		29	10	S5674_065_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	065	0		29	10	S5674_065_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					54.66	50	50	50																					50	50	50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	065	0		29	10	S5674_065_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					154.66	50	50	50																					50	50	50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5674	065	0		29	10	S5674_065_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					267.76	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5674	065	0		29	10	S5674_065_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.23	7.00	14.00	21.00																					0.23	7.00	14.00	17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5674	065	0		29	10	S5674_065_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	071	0		29	10	S5674_071_0	2	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.03	1.00	2.00	3.00																					0.03	1.00	2.00	2.50																		1.00				0.03	1.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	071	0		29	10	S5674_071_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.83	25.00	50.00	75.00																					0.83	25.00	50.00	62.50																		25.00				0.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	071	0		29	10	S5674_071_0	2	3	Preferred Brand	1	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					45.33	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	071	0		29	10	S5674_071_0	2	3	Preferred Brand	3	4	000001	3	1	111		01	111		1	30	60	90				2	30	60	90				30		31					221.13	33	33	33																					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
S5674	071	0		29	10	S5674_071_0	2	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				2	30	60	90				30		31	0.23	7.00	14.00	21.00																					0.23	7.00	14.00	17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5674	071	0		29	10	S5674_071_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					1.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	071	0		29	10	S5674_071_0	2	4	Non-Preferred Brand	1	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					45.87	50	50	50																					50	50	50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5674	071	0		29	10	S5674_071_0	2	4	Non-Preferred Brand	3	4	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					123.17	50	50	50																					50	50	50																	50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	001	0		29	10	S5715_001_0	11	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	11	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1270.00	25		25					1270.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	11	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	11	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	11	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		82.50					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.66	80.00		200.00					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.00	0.00		0.00					.16	5.00		15.00								12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	002	0		29	10	S5715_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	9	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		82.50					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5715	002	0		29	10	S5715_002_0	9	4	Non-Preferred Brand	3	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.66	80.00		200.00					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5715	002	0		29	10	S5715_002_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	002	0		29	10	S5715_002_0	9	5	Specialty Tier	3	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	003	0		29	10	S5715_003_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1270.00	25		25					1270.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	9	4	Non-Preferred Brand	3	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.66	80.00		200.00					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5715	004	0		29	10	S5715_004_0	9	5	Specialty Tier	3	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	004	0		29	10	S5715_004_0	9	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		82.50					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5715	004	0		29	10	S5715_004_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	004	0		29	10	S5715_004_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.00	0.00		0.00					.16	5.00		15.00								12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	004	0		29	10	S5715_004_0	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.66	80.00		200.00					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		82.50					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.46	44.00		132.00								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1270.00	25		25					1270.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.66	80.00		200.00					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		82.50					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	9	5	Specialty Tier	3	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	006	0		29	10	S5715_006_0	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.00	0.00		0.00					.16	5.00		15.00								12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	006	0		29	10	S5715_006_0	9	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		82.50					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5715	006	0		29	10	S5715_006_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	9	4	Non-Preferred Brand	3	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.66	80.00		200.00					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5715	006	0		29	10	S5715_006_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	010	0		29	10	S5715_010_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1270.00	25		25					1270.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		92.50					1.40	42.00		126.00								105.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.66	80.00		200.00					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		82.50					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	9	5	Specialty Tier	3	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	011	0		29	10	S5715_011_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.00	0.00		0.00					.16	5.00		15.00								12.50																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	011	0		29	10	S5715_011_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	011	0		29	10	S5715_011_0	9	3	Preferred Brand	3	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		82.50					1.33	40.00		120.00								100.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
S5715	011	0		29	10	S5715_011_0	9	4	Non-Preferred Brand	3	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.66	80.00		200.00					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5715	011	0		29	10	S5715_011_0	9	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31													1700.00	33		33					1700.00	33		33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	7	3	Preferred Brand	1	3	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.50	45.00		135.00								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					0.26	8.00		24.00								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	7	1	Preferred Generic	1	3	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		2.50					0.20	6.00		18.00								15.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	7	5	Specialty Tier	1	3	010010	1	1		110	01			1				30		90	1							30		31													1270.00	25		25					1270.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		2.50					0.23	7.00		21.00								17.50																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	7	1	Preferred Generic	1	3	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					0.16	5.00		15.00								12.50																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	7	3	Preferred Brand	1	3	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.50	45.00		135.00								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	7	5	Specialty Tier	1	3	010010	1	1		110	01			1				30		90	1							30		31													1270.00	25		25					1270.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01	100		1				30		90	1			90				30		31									.06	2.00		5.00					0.26	8.00		24.00								20.00																		8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	7	1	Preferred Generic	1	3	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		2.50					0.20	6.00		18.00								15.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	7	3	Preferred Brand	1	3	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.50	45.00		135.00								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	7	5	Specialty Tier	1	3	010010	1	1		110	01			1				30		90	1							30		31													1270.00	25		25					1270.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	7	1	Preferred Generic	1	3	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		2.50					0.20	6.00		18.00								15.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	7	2	Non-Preferred Generic	1	3	000100	1	2		110	01	100		1				30		90	1			90				30		31									0.13	4.00		10.00					0.33	10.00		30.00								25.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01	100		1				30		90	1			90				30		31									2.83	85.00		212.50					3.16	95.00		285.00								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	7	3	Preferred Brand	1	3	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.30	39.00		97.50					1.50	45.00		135.00								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	7	5	Specialty Tier	1	3	010010	1	1		110	01			1				30		90	1							30		31													1270.00	25		25					1270.00	25		25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.30	39.00	78.00	117.00					1.46	44.00	88.00	132.00					1.30	39.00	117.00	117.00																		44.00				1.29	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.43	13.00	26.00	39.00					0.16	5.00	10.00	10.00																		13.00				0.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5726	014	0		29	10	S5726_014_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													59.34	33	33	33					59.34	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	5	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	5	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	015	0		29	10	S5726_015_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	015	0		29	10	S5726_015_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	015	0		29	10	S5726_015_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	015	0		29	10	S5726_015_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	015	0		29	10	S5726_015_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5726	015	0		29	10	S5726_015_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5726	015	0		29	10	S5726_015_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													96.07	68	68	68					97.48	69	69	69					69	69	69																	69				69	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	1	
S5726	015	0		29	10	S5726_015_0	4	2	Non-Preferred Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5726	015	0		29	10	S5726_015_0	4	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													93.79	33	33	33					93.79	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	4	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.12	4.00	8.00	12.00																					.12	4.00	8.00	8.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5743	001	0		29	10	S5743_001_0	4	4	Non-Preferred Brand	1	3	110000	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31					39.27	48	48	48																					48	48	48																	48				48	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5743	001	0		29	10	S5743_001_0	4	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.22	38.00	76.00	114.00																					1.22	38.00	76.00	76.00																		38.00				1.22	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5743	001	0		29	10	S5743_001_0	4	2	Non-Preferred Generic	1	3	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.58	18.00	36.00	54.00																					.58	18.00	36.00	36.00																		18.00				.58	18.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5743	004	0		29	10	S5743_004_0	3	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					.09	3.00	6.00	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand										1		
S5743	004	0		29	10	S5743_004_0	3	4	Non-Preferred Brand	1	4	110000	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31					38.36	45	45	45																					45	45	45																	45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5743	004	0		29	10	S5743_004_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.12	35.00	70.00	105.00																					1.12	35.00	70.00	70.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5743	004	0		29	10	S5743_004_0	3	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.25	8.00	16.00	24.00																					.25	8.00	16.00	16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5743	004	0		29	10	S5743_004_0	3	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.25	8.00	16.00	24.00																					.25	8.00	16.00	16.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand										1		
S5743	004	0		29	10	S5743_004_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					.09	3.00	6.00	6.00																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5753	006	0		29	10	S5753_006_0	2	4	Non-Preferred Brand	1	3	100000	1	1	111		10	111		1	31	60	90				1	31	60	90					29	31					91.33	50	50	50																					50	50	50																		50			50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	2	3	Preferred Brand	1	3	000001	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	112.50																			45.00			1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	2	2	Non-Preferred Generic	1	3	000100	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	0.45	14.00	28.00	42.00																					0.45	14.00	28.00	35.00																			14.00			0.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	2	1	Preferred Generic	1	3	001000	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	0.19	6.00	12.00	18.00																					0.19	6.00	12.00	15.00																			6.00			0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	2	5	Specialty Tier	1	3	010010	1	1	111		10	111		1	31	60	90				2	31	60	90					29	31						28	28	28																					28	28	28																		28			28	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	2	2	Non-Preferred Generic	3	4	000100	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	0.41	13.00	26.00	39.00																					0.41	13.00	26.00	32.50																			13.00			0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5753	007	0		29	10	S5753_007_0	2	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	.09	3.00	6.00	9.00																					.09	3.00	6.00	7.50																			3.00			0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5753	007	0		29	10	S5753_007_0	2	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	31	60	90				2	31	60	90					29	31						33	33	33																					33	33	33																		33			33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	2	2	Non-Preferred Generic	1	4	000100	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	0.41	13.00	26.00	39.00																					0.41	13.00	26.00	32.50																			13.00			0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	2	4	Non-Preferred Brand	1	4	100000	1	1	111		10	111		1	31	60	90				1	31	60	90					29	31					92.32	47	47	47																					47	47	47																		47			47	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	2	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	1.35	42.00	84.00	126.00																					1.35	42.00	84.00	105.00																			42.00			1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	2	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	0.09	3.00	6.00	9.00																					.09	3.00	6.00	7.50																			3.00			.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	006	0		29	10	S5755_006_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	006	0		29	10	S5755_006_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	006	0		29	10	S5755_006_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	006	0		29	10	S5755_006_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	006	0		29	10	S5755_006_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	007	0		29	10	S5755_007_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	007	0		29	10	S5755_007_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	007	0		29	10	S5755_007_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	007	0		29	10	S5755_007_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	007	0		29	10	S5755_007_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	008	0		29	10	S5755_008_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	008	0		29	10	S5755_008_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	008	0		29	10	S5755_008_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	008	0		29	10	S5755_008_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	008	0		29	10	S5755_008_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	009	0		29	10	S5755_009_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	009	0		29	10	S5755_009_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	009	0		29	10	S5755_009_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	009	0		29	10	S5755_009_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	009	0		29	10	S5755_009_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	010	0		29	10	S5755_010_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	010	0		29	10	S5755_010_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	010	0		29	10	S5755_010_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	010	0		29	10	S5755_010_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	010	0		29	10	S5755_010_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	011	0		29	10	S5755_011_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	011	0		29	10	S5755_011_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	011	0		29	10	S5755_011_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	011	0		29	10	S5755_011_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	011	0		29	10	S5755_011_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	012	0		29	10	S5755_012_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	012	0		29	10	S5755_012_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	012	0		29	10	S5755_012_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	012	0		29	10	S5755_012_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	012	0		29	10	S5755_012_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	013	0		29	10	S5755_013_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	013	0		29	10	S5755_013_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	013	0		29	10	S5755_013_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	013	0		29	10	S5755_013_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	013	0		29	10	S5755_013_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	014	0		29	10	S5755_014_0	3	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	014	0		29	10	S5755_014_0	3	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	014	0		29	10	S5755_014_0	3	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	014	0		29	10	S5755_014_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	014	0		29	10	S5755_014_0	3	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	015	0		29	10	S5755_015_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	015	0		29	10	S5755_015_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	015	0		29	10	S5755_015_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	015	0		29	10	S5755_015_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	015	0		29	10	S5755_015_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	016	0		29	10	S5755_016_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	016	0		29	10	S5755_016_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	016	0		29	10	S5755_016_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	016	0		29	10	S5755_016_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	016	0		29	10	S5755_016_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	017	0		29	10	S5755_017_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	017	0		29	10	S5755_017_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	017	0		29	10	S5755_017_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	017	0		29	10	S5755_017_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	017	0		29	10	S5755_017_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	018	0		29	10	S5755_018_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	018	0		29	10	S5755_018_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	018	0		29	10	S5755_018_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	018	0		29	10	S5755_018_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	018	0		29	10	S5755_018_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	020	0		29	10	S5755_020_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	020	0		29	10	S5755_020_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	020	0		29	10	S5755_020_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	020	0		29	10	S5755_020_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	020	0		29	10	S5755_020_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	021	0		29	10	S5755_021_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	021	0		29	10	S5755_021_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	021	0		29	10	S5755_021_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	021	0		29	10	S5755_021_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	021	0		29	10	S5755_021_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	022	0		29	10	S5755_022_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	022	0		29	10	S5755_022_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	022	0		29	10	S5755_022_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	022	0		29	10	S5755_022_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	022	0		29	10	S5755_022_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		105.00					1.43	43.00		129.00								117.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	023	0		29	10	S5755_023_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	023	0		29	10	S5755_023_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	023	0		29	10	S5755_023_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	023	0		29	10	S5755_023_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	023	0		29	10	S5755_023_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	024	0		29	10	S5755_024_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	024	0		29	10	S5755_024_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	024	0		29	10	S5755_024_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	024	0		29	10	S5755_024_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	024	0		29	10	S5755_024_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	025	0		29	10	S5755_025_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	025	0		29	10	S5755_025_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	025	0		29	10	S5755_025_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	025	0		29	10	S5755_025_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	025	0		29	10	S5755_025_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	026	0		29	10	S5755_026_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	026	0		29	10	S5755_026_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	026	0		29	10	S5755_026_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	026	0		29	10	S5755_026_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	026	0		29	10	S5755_026_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	028	0		29	10	S5755_028_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	028	0		29	10	S5755_028_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	028	0		29	10	S5755_028_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	028	0		29	10	S5755_028_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	028	0		29	10	S5755_028_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	029	0		29	10	S5755_029_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	029	0		29	10	S5755_029_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	029	0		29	10	S5755_029_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	029	0		29	10	S5755_029_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	029	0		29	10	S5755_029_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	030	0		29	10	S5755_030_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	030	0		29	10	S5755_030_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	030	0		29	10	S5755_030_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	030	0		29	10	S5755_030_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	030	0		29	10	S5755_030_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	031	0		29	10	S5755_031_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	031	0		29	10	S5755_031_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	031	0		29	10	S5755_031_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	031	0		29	10	S5755_031_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	031	0		29	10	S5755_031_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	032	0		29	10	S5755_032_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	032	0		29	10	S5755_032_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	032	0		29	10	S5755_032_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	032	0		29	10	S5755_032_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	032	0		29	10	S5755_032_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	033	0		29	10	S5755_033_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	033	0		29	10	S5755_033_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	033	0		29	10	S5755_033_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	033	0		29	10	S5755_033_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	033	0		29	10	S5755_033_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	034	0		29	10	S5755_034_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	034	0		29	10	S5755_034_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	034	0		29	10	S5755_034_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	034	0		29	10	S5755_034_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	034	0		29	10	S5755_034_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	035	0		29	10	S5755_035_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	035	0		29	10	S5755_035_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	035	0		29	10	S5755_035_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	035	0		29	10	S5755_035_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	035	0		29	10	S5755_035_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								42.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		111.00					1.50	45.00		135.00								122.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	039	0		29	10	S5755_039_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	039	0		29	10	S5755_039_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	039	0		29	10	S5755_039_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	039	0		29	10	S5755_039_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	039	0		29	10	S5755_039_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									0.76	23.00		69.00					1.03	31.00		93.00								84.00																		31.00				1.00	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	073	0		29	10	S5755_073_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	073	0		29	10	S5755_073_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	073	0		29	10	S5755_073_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	073	0		29	10	S5755_073_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.06	32.00		96.00					1.33	40.00		120.00								108.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	073	0		29	10	S5755_073_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	074	0		29	10	S5755_074_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	074	0		29	10	S5755_074_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	074	0		29	10	S5755_074_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		111.00					1.50	45.00		135.00								122.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	074	0		29	10	S5755_074_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	074	0		29	10	S5755_074_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.20	36.00		108.00					1.46	44.00		132.00								119.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		111.00					1.50	45.00		135.00								122.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		105.00					1.43	43.00		129.00								117.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	078	0		29	10	S5755_078_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	078	0		29	10	S5755_078_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	078	0		29	10	S5755_078_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.06	32.00		96.00					1.33	40.00		120.00								108.00																		40.00				1.29	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	078	0		29	10	S5755_078_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	078	0		29	10	S5755_078_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		105.00					1.43	43.00		129.00								117.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	080	0		29	10	S5755_080_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	080	0		29	10	S5755_080_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	080	0		29	10	S5755_080_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	080	0		29	10	S5755_080_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	080	0		29	10	S5755_080_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.13	34.00		102.00					1.40	42.00		126.00								114.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	081	0		29	10	S5755_081_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	081	0		29	10	S5755_081_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	081	0		29	10	S5755_081_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	081	0		29	10	S5755_081_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	081	0		29	10	S5755_081_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									0.93	28.00		84.00					1.20	36.00		108.00								98.00																		36.00				1.16	36.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	082	0		29	10	S5755_082_0	3	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					1.36	41.00		123.00								111.00																		41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	082	0		29	10	S5755_082_0	3	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	082	0		29	10	S5755_082_0	3	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	082	0		29	10	S5755_082_0	3	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	082	0		29	10	S5755_082_0	3	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									0.90	27.00		81.00					1.16	35.00		105.00								95.00																		35.00				1.12	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	084	0		29	10	S5755_084_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	084	0		29	10	S5755_084_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.20	36.00		108.00					1.46	44.00		132.00								119.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	084	0		29	10	S5755_084_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	084	0		29	10	S5755_084_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	084	0		29	10	S5755_084_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	085	0		29	10	S5755_085_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	085	0		29	10	S5755_085_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	085	0		29	10	S5755_085_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		111.00					1.50	45.00		135.00								122.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	085	0		29	10	S5755_085_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	085	0		29	10	S5755_085_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	086	0		29	10	S5755_086_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	086	0		29	10	S5755_086_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	086	0		29	10	S5755_086_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	086	0		29	10	S5755_086_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	086	0		29	10	S5755_086_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.13	34.00		102.00					1.40	42.00		126.00								114.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	087	0		29	10	S5755_087_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	087	0		29	10	S5755_087_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	087	0		29	10	S5755_087_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		111.00					1.50	45.00		135.00								122.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	087	0		29	10	S5755_087_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	087	0		29	10	S5755_087_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.00	30.00		90.00					1.26	38.00		114.00								103.00																		38.00				1.22	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	089	0		29	10	S5755_089_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					1.36	41.00		123.00								111.00																		41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	089	0		29	10	S5755_089_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	089	0		29	10	S5755_089_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	089	0		29	10	S5755_089_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	089	0		29	10	S5755_089_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									0.93	28.00		84.00					1.20	36.00		108.00								98.00																		36.00				1.16	36.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.03	31.00		93.00					1.30	39.00		117.00								106.00																		39.00				1.25	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		111.00					1.50	45.00		135.00								122.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	094	0		29	10	S5755_094_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	094	0		29	10	S5755_094_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.13	34.00		102.00					1.40	42.00		126.00								114.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	094	0		29	10	S5755_094_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	094	0		29	10	S5755_094_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	094	0		29	10	S5755_094_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	095	0		29	10	S5755_095_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	095	0		29	10	S5755_095_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		105.00					1.43	43.00		129.00								117.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	095	0		29	10	S5755_095_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	095	0		29	10	S5755_095_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	095	0		29	10	S5755_095_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	096	0		29	10	S5755_096_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	096	0		29	10	S5755_096_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		105.00					1.43	43.00		129.00								117.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	096	0		29	10	S5755_096_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	096	0		29	10	S5755_096_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	096	0		29	10	S5755_096_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	097	0		29	10	S5755_097_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	097	0		29	10	S5755_097_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	097	0		29	10	S5755_097_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		111.00					1.50	45.00		135.00								122.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	097	0		29	10	S5755_097_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	097	0		29	10	S5755_097_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	098	0		29	10	S5755_098_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	098	0		29	10	S5755_098_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	098	0		29	10	S5755_098_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		111.00					1.50	45.00		135.00								122.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	098	0		29	10	S5755_098_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	098	0		29	10	S5755_098_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	099	0		29	10	S5755_099_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	099	0		29	10	S5755_099_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	099	0		29	10	S5755_099_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		111.00					1.50	45.00		135.00								122.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	099	0		29	10	S5755_099_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	099	0		29	10	S5755_099_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	100	0		29	10	S5755_100_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	100	0		29	10	S5755_100_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	100	0		29	10	S5755_100_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		111.00					1.50	45.00		135.00								122.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	100	0		29	10	S5755_100_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	100	0		29	10	S5755_100_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	101	0		29	10	S5755_101_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	101	0		29	10	S5755_101_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	101	0		29	10	S5755_101_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.10	33.00		99.00					1.36	41.00		123.00								111.00																		41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	101	0		29	10	S5755_101_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	101	0		29	10	S5755_101_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	102	0		29	10	S5755_102_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	102	0		29	10	S5755_102_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	102	0		29	10	S5755_102_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.16	35.00		105.00					1.43	43.00		129.00								117.00																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	102	0		29	10	S5755_102_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	102	0		29	10	S5755_102_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	2	1	Preferred Generic	1	2	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	2	2	Non-Preferred Generic	1	2	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.16	5.00		15.00					0.43	13.00		39.00								36.00																		13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.20	36.00		108.00					1.46	44.00		132.00								119.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		285.00					3.16	95.00		285.00								257.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	106	0		29	10	S5755_106_0	2	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31									0.03	1.00		3.00					0.30	9.00		27.00								0.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	106	0		29	10	S5755_106_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31									0.23	7.00		21.00					0.50	15.00		45.00								39.00																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	106	0		29	10	S5755_106_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31									3.16	95.00		238.00					3.16	95.00		238.00								190.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	106	0		29	10	S5755_106_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31									1.23	37.00		93.00					1.50	45.00		113.00								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	106	0		29	10	S5755_106_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31													1.00	30		30					1.00	30		30							30																	30				30	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5766	002	0		29	10	S5766_002_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01			1				34	60	90	2							34		34									.29	10.00	20.00	20.00					.88	30.00	60.00	60.00																										30.00				.88	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5766	002	0		29	10	S5766_002_0	4	1	Preferred Generic	1	3	001000	1	2		111	01			1				34	60	90	2							34		34									.08	3.00	6.00	6.00					.23	8.00	16.00	16.00																										8.00				.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5766	002	0		29	10	S5766_002_0	4	3	Preferred Brand	1	3	000001	1	1		111	01			1				34	60	90	2							34		34													27.67	15	15	15					37.05	20	20	20																								20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5766	002	0		29	10	S5766_002_0	4	4	Non-Preferred Brand	1	3	100000	1	1		111	01			1				34	60	90	2							34		34													50.34	30	30	30					58.99	35	35	35																								35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5766	002	0		29	10	S5766_002_0	4	5	Specialty Tier	1	3	010010	1	1		111	01			1				34	60	90	2							34		34													1.00	25	25	25					1.00	25	25	25																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5766	003	0		29	10	S5766_003_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				34	60	90	2							34		34									.29	10.00	20.00	20.00					.88	30.00	60.00	60.00																										30.00				.88	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5766	003	0		29	10	S5766_003_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				34	60	90	2							34		34									.08	3.00	6.00	6.00					.23	8.00	16.00	16.00																										8.00				.23	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5766	003	0		29	10	S5766_003_0	4	3	Preferred Brand	1	4	000001	1	1		111	01			1				34	60	90	2							34		34													28.11	15	15	15					37.63	20	20	20																								20				20	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5766	003	0		29	10	S5766_003_0	4	2	Non-Preferred Generic	3	4	000100	1	2		111	01			1				34	60	90	2							34		34									.29	10.00	20.00	20.00					.88	30.00	60.00	60.00																										30.00				.88	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5766	003	0		29	10	S5766_003_0	4	1	Preferred Generic	3	4	001000	1	2		111	01			1				34	60	90	2							34		34									.09	3.00	6.00	6.00					.24	8.00	16.00	16.00																										8.00				.24	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5766	003	0		29	10	S5766_003_0	4	4	Non-Preferred Brand	1	4	100000	1	1		111	01			1				34	60	90	2							34		34													51.28	30	30	30					60.09	35	35	35																								35				35	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5766	003	0		29	10	S5766_003_0	4	5	Specialty Tier	1	4	010010	1	1		111	01			1				34	60	90	2							34		34													1.00	33	33	33					1.00	33	33	33																								33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	005	0		29	10	S5768_005_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													33.02	15	15	15					33.81	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	005	0		29	10	S5768_005_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	005	0		29	10	S5768_005_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													26.68	42	42	42					26.90	43	43	43					42	42	42																	43				43	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	007	0		29	10	S5768_007_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													24.67	44	44	44					24.87	45	45	45					44	44	44																	45				45	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	007	0		29	10	S5768_007_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	007	0		29	10	S5768_007_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													34.43	15	15	15					35.22	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	008	0		29	10	S5768_008_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	008	0		29	10	S5768_008_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													32.00	15	15	15					32.75	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	008	0		29	10	S5768_008_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													25.60	43	43	43					25.81	44	44	44					43	43	43																	44				44	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	009	0		29	10	S5768_009_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													30.94	15	15	15					31.88	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	009	0		29	10	S5768_009_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	009	0		29	10	S5768_009_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													24.13	46	46	46					24.37	47	47	47					46	46	46																	47				47	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	010	0		29	10	S5768_010_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	010	0		29	10	S5768_010_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													30.62	15	15	15					31.45	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	010	0		29	10	S5768_010_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													23.96	44	44	44					24.18	45	45	45					44	44	44																	45				45	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	012	0		29	10	S5768_012_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	012	0		29	10	S5768_012_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													31.06	15	15	15					31.90	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	012	0		29	10	S5768_012_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													22.97	45	45	45					23.18	46	46	46					45	45	45																	46				46	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	015	0		29	10	S5768_015_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	015	0		29	10	S5768_015_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													30.10	15	15	15					30.88	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	015	0		29	10	S5768_015_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													22.62	45	45	45					22.82	46	46	46					45	45	45																	46				46	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	016	0		29	10	S5768_016_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													31.08	15	15	15					31.81	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	016	0		29	10	S5768_016_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	016	0		29	10	S5768_016_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													25.00	44	44	44					25.19	45	45	45					44	44	44																	45				45	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	017	0		29	10	S5768_017_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													31.04	15	15	15					32.05	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	017	0		29	10	S5768_017_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	017	0		29	10	S5768_017_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													23.92	46	46	46					24.18	47	47	47					46	46	46																	47				47	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	018	0		29	10	S5768_018_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	018	0		29	10	S5768_018_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													30.81	15	15	15					31.66	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	018	0		29	10	S5768_018_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													23.48	46	46	46					23.69	47	47	47					46	46	46																	47				47	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	021	0		29	10	S5768_021_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	021	0		29	10	S5768_021_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													32.07	15	15	15					32.95	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	021	0		29	10	S5768_021_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													24.41	46	46	46					24.62	47	47	47					46	46	46																	47				47	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	031	0		29	10	S5768_031_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													32.52	15	15	15					33.35	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	031	0		29	10	S5768_031_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	031	0		29	10	S5768_031_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													23.60	43	43	43					23.81	44	44	44					43	43	43																	44				44	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	038	0		29	10	S5768_038_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	038	0		29	10	S5768_038_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													31.50	15	15	15					32.19	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	038	0		29	10	S5768_038_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													25.38	44	44	44					25.57	45	45	45					44	44	44																	45				45	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	039	0		29	10	S5768_039_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													32.06	15	15	15					33.01	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	039	0		29	10	S5768_039_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	039	0		29	10	S5768_039_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													23.89	46	46	46					24.12	47	47	47					46	46	46																	47				47	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	040	0		29	10	S5768_040_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	040	0		29	10	S5768_040_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													30.91	15	15	15					31.80	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	040	0		29	10	S5768_040_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													23.17	45	45	45					23.39	46	46	46					45	45	45																	46				46	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	041	0		29	10	S5768_041_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	041	0		29	10	S5768_041_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													33.28	15	15	15					34.02	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	041	0		29	10	S5768_041_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													24.76	44	44	44					24.95	45	45	45					44	44	44																	45				45	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	042	0		29	10	S5768_042_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													31.23	15	15	15					31.96	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	042	0		29	10	S5768_042_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	042	0		29	10	S5768_042_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													25.14	47	47	47					25.32	48	48	48					47	47	47																	48				48	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	043	0		29	10	S5768_043_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	043	0		29	10	S5768_043_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													30.66	15	15	15					31.58	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	043	0		29	10	S5768_043_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													23.93	47	47	47					24.15	48	48	48					47	47	47																	48				48	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	045	0		29	10	S5768_045_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	045	0		29	10	S5768_045_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													31.08	15	15	15					31.91	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	045	0		29	10	S5768_045_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													25.87	44	44	44					26.11	45	45	45					44	44	44																	45				45	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	048	0		29	10	S5768_048_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	048	0		29	10	S5768_048_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													30.98	15	15	15					31.72	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	048	0		29	10	S5768_048_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													26.34	40	40	40					26.56	41	41	41					40	40	40																	41				41	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	082	0		29	10	S5768_082_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	082	0		29	10	S5768_082_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													32.35	15	15	15					33.10	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	082	0		29	10	S5768_082_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													26.84	42	42	42					27.06	43	43	43					42	42	42																	43				43	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	083	0		29	10	S5768_083_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	083	0		29	10	S5768_083_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													31.32	15	15	15					32.02	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	083	0		29	10	S5768_083_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													24.98	45	45	45					25.16	46	46	46					45	45	45																	46				46	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	117	0		29	10	S5768_117_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													31.13	15	15	15					33.52	18	18	18					15	15	15																	18				18	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	117	0		29	10	S5768_117_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	117	0		29	10	S5768_117_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													22.73	39	39	39					23.42	42	42	42					39	39	39																	42				42	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	118	0		29	10	S5768_118_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	118	0		29	10	S5768_118_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													30.61	15	15	15					31.60	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	118	0		29	10	S5768_118_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													22.50	44	44	44					22.74	45	45	45					44	44	44																	45				45	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	119	0		29	10	S5768_119_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	119	0		29	10	S5768_119_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													33.32	15	15	15					34.39	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	119	0		29	10	S5768_119_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													24.78	42	42	42					25.06	43	43	43					42	42	42																	43				43	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	122	0		29	10	S5768_122_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													22.60	46	46	46					22.79	47	47	47					46	46	46																	47				47	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	122	0		29	10	S5768_122_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	122	0		29	10	S5768_122_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													29.51	15	15	15					30.30	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	123	0		29	10	S5768_123_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	123	0		29	10	S5768_123_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													29.45	15	15	15					30.36	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	123	0		29	10	S5768_123_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													23.80	45	45	45					24.04	46	46	46					45	45	45																	46				46	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	125	0		29	10	S5768_125_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	5	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	5	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	5	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	5	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	5	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	5	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	5	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	5	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	5	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	5	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	5	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	5	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31													1.00	33							1.00	33																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01			1				30	60	90	2							30		31									2.93	88.00	176.00	264.00					3.16	95.00	190.00	285.00																										95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	4	3	Preferred Brand	1	4	000001	1	2		111	01			1				30	60	90	2							30		31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00																										45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01			1				30	60	90	2							30		31									0.36	11.00	22.00	33.00					1.10	33.00	66.00	99.00																										33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	4	1	Preferred Generic	1	4	001000	1	2		111	01			1				30	60	90	2							30		31									0.10	3.00	6.00	9.00					0.33	10.00	20.00	30.00																										10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	158	0		29	10	S5768_158_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													31.66	15	15	15					32.65	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	158	0		29	10	S5768_158_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													22.65	45	45	45					22.88	46	46	46					45	45	45																	46				46	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	158	0		29	10	S5768_158_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	159	0		29	10	S5768_159_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													22.80	42	42	42					23.02	43	43	43					42	42	42																	43				43	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	159	0		29	10	S5768_159_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													33.58	15	15	15					34.49	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	159	0		29	10	S5768_159_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	160	0		29	10	S5768_160_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	160	0		29	10	S5768_160_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													31.69	15	15	15					32.59	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	160	0		29	10	S5768_160_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													23.22	46	46	46					23.42	47	47	47					46	46	46																	47				47	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	161	0		29	10	S5768_161_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													29.19	15	15	15					30.15	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	161	0		29	10	S5768_161_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													21.92	44	44	44					22.16	45	45	45					44	44	44																	45				45	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	161	0		29	10	S5768_161_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	162	0		29	10	S5768_162_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													24.59	44	44	44					24.82	45	45	45					44	44	44																	45				45	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	162	0		29	10	S5768_162_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													31.74	15	15	15					32.57	16	16	16					15	15	15																	16				16	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	162	0		29	10	S5768_162_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	163	0		29	10	S5768_163_0	3	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31									.03	1.00	2.00	3.00					.10	3.00	6.00	9.00					.03	1.00	2.00	3.00																		3.00				.09	3.00		Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	163	0		29	10	S5768_163_0	3	2	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													37.88	15	15	15					40.06	18	18	18					15	15	15																	18				18	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5768	163	0		29	10	S5768_163_0	3	3	Non-Preferred Brand	1	2	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31													25.90	35	35	35					26.57	38	38	38					35	35	35																	38				38	Preferred Generic, Preferred Brand, Non-Preferred Brand												
S5775	001	0		29	10	S5775_001_0	2	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									.83	25.00		75.00					1.33	40.00		120.00								75.00																		40.00				.81	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5775	001	0		29	10	S5775_001_0	2	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31													500.00	33		33					500.00	33		33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5775	001	0		29	10	S5775_001_0	2	4	Non-Preferred Brand	1	4	100000	3	2		110	01	100		1				30		90	1			90				30		31									1.83	55.00		165.00					2.33	70.00		210.00								165.00																		70.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5775	001	0		29	10	S5775_001_0	2	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.17	5.00		15.00					.33	10.00		30.00								15.00																		10.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5775	001	0		29	10	S5775_001_0	2	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									0.00	0.00		0.00					.20	6.00		18.00								0.00																		6.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5775	002	0		29	10	S5775_002_0	2	3	Preferred Brand	1	3	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.00	30.00		90.00					1.50	45.00		135.00								90.00																		45.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5775	002	0		29	10	S5775_002_0	2	2	Non-Preferred Generic	1	3	000100	1	2		110	01	100		1				30		90	1			90				30		31									.17	5.00		15.00					.37	11.00		33.00								15.00																		11.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5775	002	0		29	10	S5775_002_0	2	1	Preferred Generic	1	3	001000	1	2		110	01	100		1				30		90	1			90				30		31									.10	3.00		9.00					.23	7.00		21.00								9.00																		7.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5775	002	0		29	10	S5775_002_0	2	5	Specialty Tier	1	3	100100	1	1		110	01	100		1				30		90	1			90				30		31													500.00	25		25					500.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5775	002	0		29	10	S5775_002_0	2	4	Non-Preferred Brand	1	3	100000	1	2		110	01	100		1				30		90	1			90				30		31									2.00	60.00		180.00					2.50	75.00		225.00								120.00																		75.00				1.94	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		6.00																					.10	3.00		6.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.10	3.00		6.00																					.10	3.00		6.00																		3.00				.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5795	002	0		29	10	S5795_002_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					470.84	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		225.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		112.50																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	6	2	Non-Preferred Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.50	15.00		37.50																					.50	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5795	002	0		29	10	S5795_002_0	6	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.50	15.00		37.50																					.50	15.00		37.50																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	2	5	Specialty Tier	1	3	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					578.12	25		25																					25		25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	2	4	Non-Preferred Brand	1	3	110000	1	1	110		01	110		1	30		90				1	30		90				30		31					29.88	41		41																					41		41																	41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	2	3	Preferred Brand	1	3	000001	1	1	110		01	110		1	30		90				1	30		90				30		31					44.23	22		22																					22		22																	22				22	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	2	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	.50	15.00		30.00																					.50	15.00		30.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	2	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.13	4.00		8.00																					.13	4.00		8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.16	5.00		15.00															0.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.30	9.00		27.00															6.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													559.00	33		33					559.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.30	39.00		117.00					1.36	41.00		123.00															112.00							123.00				41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	3	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	035	0		29	10	S5810_035_0	3	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00												1.16	35.00	70.00	105.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	035	0		29	10	S5810_035_0	3	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00												3.00	90.00	180.00	270.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	035	0		29	10	S5810_035_0	3	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	035	0		29	10	S5810_035_0	3	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	036	0		29	10	S5810_036_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	036	0		29	10	S5810_036_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	036	0		29	10	S5810_036_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	036	0		29	10	S5810_036_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	036	0		29	10	S5810_036_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	037	0		29	10	S5810_037_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	037	0		29	10	S5810_037_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	037	0		29	10	S5810_037_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	037	0		29	10	S5810_037_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	037	0		29	10	S5810_037_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	038	0		29	10	S5810_038_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	038	0		29	10	S5810_038_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	038	0		29	10	S5810_038_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	038	0		29	10	S5810_038_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.26	38.00	76.00	114.00					1.50	45.00	90.00	135.00												1.26	38.00	76.00	114.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	038	0		29	10	S5810_038_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	039	0		29	10	S5810_039_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	039	0		29	10	S5810_039_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	039	0		29	10	S5810_039_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.20	36.00	72.00	108.00					1.50	45.00	90.00	135.00												1.20	36.00	72.00	108.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	039	0		29	10	S5810_039_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	039	0		29	10	S5810_039_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	040	0		29	10	S5810_040_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	040	0		29	10	S5810_040_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	040	0		29	10	S5810_040_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	040	0		29	10	S5810_040_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	040	0		29	10	S5810_040_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.23	37.00	74.00	111.00					1.50	45.00	90.00	135.00												1.23	37.00	74.00	111.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	041	0		29	10	S5810_041_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	041	0		29	10	S5810_041_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00												1.33	40.00	80.00	120.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	041	0		29	10	S5810_041_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	041	0		29	10	S5810_041_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	041	0		29	10	S5810_041_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	042	0		29	10	S5810_042_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	042	0		29	10	S5810_042_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	042	0		29	10	S5810_042_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	042	0		29	10	S5810_042_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	042	0		29	10	S5810_042_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	043	0		29	10	S5810_043_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.20	6.00	12.00	18.00												.03	1.00	2.00	3.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	043	0		29	10	S5810_043_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	043	0		29	10	S5810_043_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	043	0		29	10	S5810_043_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.23	7.00	14.00	21.00												.06	2.00	4.00	4.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	043	0		29	10	S5810_043_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	044	0		29	10	S5810_044_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.16	5.00	10.00	15.00												.03	1.00	2.00	3.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	044	0		29	10	S5810_044_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.20	6.00	12.00	18.00												.06	2.00	4.00	4.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	044	0		29	10	S5810_044_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	044	0		29	10	S5810_044_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	044	0		29	10	S5810_044_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	045	0		29	10	S5810_045_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.20	6.00	12.00	18.00												.03	1.00	2.00	3.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	045	0		29	10	S5810_045_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	045	0		29	10	S5810_045_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	045	0		29	10	S5810_045_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.23	7.00	14.00	21.00												.06	2.00	4.00	4.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	045	0		29	10	S5810_045_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	046	0		29	10	S5810_046_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.20	36.00	72.00	108.00					1.50	45.00	90.00	135.00												1.20	36.00	72.00	108.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	046	0		29	10	S5810_046_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00												3.00	90.00	180.00	270.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	046	0		29	10	S5810_046_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	046	0		29	10	S5810_046_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	046	0		29	10	S5810_046_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	047	0		29	10	S5810_047_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	047	0		29	10	S5810_047_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.26	38.00	76.00	114.00					1.50	45.00	90.00	135.00												1.26	38.00	76.00	114.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	047	0		29	10	S5810_047_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	047	0		29	10	S5810_047_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	047	0		29	10	S5810_047_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	048	0		29	10	S5810_048_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	048	0		29	10	S5810_048_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	048	0		29	10	S5810_048_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	048	0		29	10	S5810_048_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	048	0		29	10	S5810_048_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	049	0		29	10	S5810_049_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.46	44.00	88.00	132.00					1.50	45.00	90.00	135.00												1.46	44.00	88.00	132.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	049	0		29	10	S5810_049_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	049	0		29	10	S5810_049_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.16	5.00	10.00	15.00												.03	1.00	2.00	3.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	049	0		29	10	S5810_049_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	049	0		29	10	S5810_049_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.20	6.00	12.00	18.00												.06	2.00	4.00	4.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	050	0		29	10	S5810_050_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	050	0		29	10	S5810_050_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	050	0		29	10	S5810_050_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	050	0		29	10	S5810_050_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	050	0		29	10	S5810_050_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00												1.33	40.00	80.00	120.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	051	0		29	10	S5810_051_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	051	0		29	10	S5810_051_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	051	0		29	10	S5810_051_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	051	0		29	10	S5810_051_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	051	0		29	10	S5810_051_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	052	0		29	10	S5810_052_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	052	0		29	10	S5810_052_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	052	0		29	10	S5810_052_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	052	0		29	10	S5810_052_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	052	0		29	10	S5810_052_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.36	41.00	82.00	123.00					1.50	45.00	90.00	135.00												1.36	41.00	82.00	123.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	053	0		29	10	S5810_053_0	2	2	Preferred Brand	1	2	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.40	42.00	84.00	126.00																												1.40	42.00	84.00	126.00				1.40	42.00	84.00	126.00					42.00			1.35	42.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	053	0		29	10	S5810_053_0	2	3	Non-Preferred Brand	1	2	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	053	0		29	10	S5810_053_0	2	4	Specialty Tier	1	2	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	053	0		29	10	S5810_053_0	2	5	Select Care Drugs	1	2	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	3.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	053	0		29	10	S5810_053_0	2	1	Generic	1	2	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.10	3.00	6.00	9.00																												.10	3.00	4.00	4.00				.10	3.00	6.00	9.00					3.00			.09	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	054	0		29	10	S5810_054_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	054	0		29	10	S5810_054_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	054	0		29	10	S5810_054_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	054	0		29	10	S5810_054_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.43	43.00	86.00	129.00					1.50	45.00	90.00	135.00												1.43	43.00	86.00	129.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	054	0		29	10	S5810_054_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	055	0		29	10	S5810_055_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.06	92.00	184.00	276.00					3.16	95.00	190.00	285.00												3.02	92.00	184.00	276.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	055	0		29	10	S5810_055_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	055	0		29	10	S5810_055_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	055	0		29	10	S5810_055_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	055	0		29	10	S5810_055_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.20	36.00	72.00	108.00					1.50	45.00	90.00	135.00												1.20	36.00	72.00	108.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	056	0		29	10	S5810_056_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	056	0		29	10	S5810_056_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.20	6.00	12.00	18.00												.03	1.00	2.00	3.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	056	0		29	10	S5810_056_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	056	0		29	10	S5810_056_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	056	0		29	10	S5810_056_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.23	7.00	14.00	21.00												.06	2.00	4.00	4.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	057	0		29	10	S5810_057_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	057	0		29	10	S5810_057_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.40	42.00	84.00	126.00					1.50	45.00	90.00	135.00												1.40	42.00	84.00	126.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	057	0		29	10	S5810_057_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.13	94.00	188.00	282.00					3.16	95.00	190.00	285.00												3.13	94.00	188.00	282.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	057	0		29	10	S5810_057_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	057	0		29	10	S5810_057_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	058	0		29	10	S5810_058_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	058	0		29	10	S5810_058_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.26	38.00	76.00	114.00					1.50	45.00	90.00	135.00												1.26	38.00	76.00	114.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	058	0		29	10	S5810_058_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	058	0		29	10	S5810_058_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	058	0		29	10	S5810_058_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	059	0		29	10	S5810_059_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.16	35.00	70.00	105.00					1.50	45.00	90.00	135.00												1.16	35.00	70.00	105.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	059	0		29	10	S5810_059_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	059	0		29	10	S5810_059_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	059	0		29	10	S5810_059_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	059	0		29	10	S5810_059_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	060	0		29	10	S5810_060_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.10	3.00	6.00	9.00					.30	9.00	18.00	27.00												.10	3.00	4.00	4.00				.30	9.00	18.00	27.00					9.00			.29	9.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	060	0		29	10	S5810_060_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	060	0		29	10	S5810_060_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.23	7.00	14.00	21.00												.03	1.00	2.00	3.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	060	0		29	10	S5810_060_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	060	0		29	10	S5810_060_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	061	0		29	10	S5810_061_0	2	1	Generic	1	2	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.10	3.00	6.00	9.00																												.10	3.00	4.00	4.00				.10	3.00	6.00	9.00					3.00			.09	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	061	0		29	10	S5810_061_0	2	5	Select Care Drugs	1	2	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	3.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	061	0		29	10	S5810_061_0	2	4	Specialty Tier	1	2	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	061	0		29	10	S5810_061_0	2	3	Non-Preferred Brand	1	2	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	061	0		29	10	S5810_061_0	2	2	Preferred Brand	1	2	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.50	45.00	90.00	135.00																												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	062	0		29	10	S5810_062_0	2	2	Preferred Brand	1	2	010001	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													21.83	24	24	24					21.83	24	24	24												24	24	24					24	24	24				24			24	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	062	0		29	10	S5810_062_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	062	0		29	10	S5810_062_0	2	3	Non-Preferred Brand	1	2	110000	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													70.71	45	45	45					70.71	45	45	45												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	062	0		29	10	S5810_062_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	062	0		29	10	S5810_062_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	063	0		29	10	S5810_063_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	063	0		29	10	S5810_063_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.30	9.00	18.00	27.00												.03	1.00	2.00	3.00				.30	9.00	18.00	27.00					9.00			.29	9.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	063	0		29	10	S5810_063_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	063	0		29	10	S5810_063_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	063	0		29	10	S5810_063_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.33	10.00	20.00	30.00												.06	2.00	4.00	4.00				.33	10.00	20.00	30.00					10.00			.32	10.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	064	0		29	10	S5810_064_0	2	5	Select Care Drugs	1	2	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	3.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	064	0		29	10	S5810_064_0	2	2	Preferred Brand	1	2	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.43	43.00	86.00	129.00																												1.43	43.00	86.00	129.00				1.43	43.00	86.00	129.00					43.00			1.38	43.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	064	0		29	10	S5810_064_0	2	3	Non-Preferred Brand	1	2	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	064	0		29	10	S5810_064_0	2	4	Specialty Tier	1	2	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	064	0		29	10	S5810_064_0	2	1	Generic	1	2	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.10	3.00	6.00	9.00																												.10	3.00	4.00	4.00				.10	3.00	6.00	9.00					3.00			.09	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	065	0		29	10	S5810_065_0	2	3	Non-Preferred Brand	1	2	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.16	95.00	190.00	285.00																												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	065	0		29	10	S5810_065_0	2	2	Preferred Brand	1	2	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.43	43.00	86.00	129.00																												1.43	43.00	86.00	129.00				1.43	43.00	86.00	129.00					43.00			1.38	43.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	065	0		29	10	S5810_065_0	2	1	Generic	1	2	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.10	3.00	6.00	9.00																												.10	3.00	4.00	4.00				.10	3.00	6.00	9.00					3.00			.09	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	065	0		29	10	S5810_065_0	2	4	Specialty Tier	1	2	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	065	0		29	10	S5810_065_0	2	5	Select Care Drugs	1	2	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	3.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	066	0		29	10	S5810_066_0	3	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	066	0		29	10	S5810_066_0	3	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.13	4.00	8.00	12.00												.03	1.00	2.00	3.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	066	0		29	10	S5810_066_0	3	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	066	0		29	10	S5810_066_0	3	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.30	39.00	78.00	117.00					1.50	45.00	90.00	135.00												1.30	39.00	78.00	117.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	066	0		29	10	S5810_066_0	3	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.06	2.00	4.00	6.00					.16	5.00	10.00	15.00												.06	2.00	4.00	4.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	067	0		29	10	S5810_067_0	2	4	Specialty Tier	1	2	010010	1	1		111	10		111	1				30	60	90	1				30	60	90		10	31													1.00	25	25	25					1.00	25	25	25												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	067	0		29	10	S5810_067_0	2	2	Preferred Brand	1	2	010001	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									1.50	45.00	90.00	135.00					1.50	45.00	90.00	135.00												1.50	45.00	90.00	135.00				1.50	45.00	90.00	135.00					45.00			1.45	45.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	067	0		29	10	S5810_067_0	2	1	Generic	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.10	3.00	6.00	9.00					.30	9.00	18.00	27.00												.10	3.00	4.00	4.00				.30	9.00	18.00	27.00					9.00			.29	9.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	067	0		29	10	S5810_067_0	2	3	Non-Preferred Brand	1	2	110000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00												3.16	95.00	190.00	285.00				3.16	95.00	190.00	285.00					95.00			3.06	95.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	067	0		29	10	S5810_067_0	2	5	Select Care Drugs	1	2	010000	1	2		111	10		111	1				30	60	90	1				30	60	90		10	31									.03	1.00	2.00	3.00					.23	7.00	14.00	21.00												.03	1.00	2.00	3.00				.23	7.00	14.00	21.00					7.00			.22	7.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	068	0		29	10	S5810_068_0	2	5	Select Care Drugs	1	2	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	3.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	068	0		29	10	S5810_068_0	2	4	Specialty Tier	1	2	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	068	0		29	10	S5810_068_0	2	1	Generic	1	2	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	068	0		29	10	S5810_068_0	2	2	Preferred Brand	1	2	010001	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	1.23	37.00	74.00	111.00																												1.23	37.00	74.00	111.00				1.23	37.00	74.00	111.00					37.00			1.19	37.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	068	0		29	10	S5810_068_0	2	3	Non-Preferred Brand	1	2	110000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	3.03	91.00	182.00	273.00																												3.03	91.00	182.00	273.00				3.03	91.00	182.00	273.00					91.00			2.93	91.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	172	0		29	10	S5810_172_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	172	0		29	10	S5810_172_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					85.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	172	0		29	10	S5810_172_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					34.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	172	0		29	10	S5810_172_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	172	0		29	10	S5810_172_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	172	0		29	10	S5810_172_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	174	0		29	10	S5810_174_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					86.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	174	0		29	10	S5810_174_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	174	0		29	10	S5810_174_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	174	0		29	10	S5810_174_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	174	0		29	10	S5810_174_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	174	0		29	10	S5810_174_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	175	0		29	10	S5810_175_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	175	0		29	10	S5810_175_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					90.00	44	44	44																												44	44	44					44	44	44				44			44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	175	0		29	10	S5810_175_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	175	0		29	10	S5810_175_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	175	0		29	10	S5810_175_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	175	0		29	10	S5810_175_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					34.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	176	0		29	10	S5810_176_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	176	0		29	10	S5810_176_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	176	0		29	10	S5810_176_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	176	0		29	10	S5810_176_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.00	43	43	43																												43	43	43					43	43	43				43			43	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	176	0		29	10	S5810_176_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					37.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	176	0		29	10	S5810_176_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	177	0		29	10	S5810_177_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					37.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	177	0		29	10	S5810_177_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					75.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	177	0		29	10	S5810_177_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	177	0		29	10	S5810_177_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00					3.00			.09	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	177	0		29	10	S5810_177_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	177	0		29	10	S5810_177_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	178	0		29	10	S5810_178_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					35.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	178	0		29	10	S5810_178_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	178	0		29	10	S5810_178_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	178	0		29	10	S5810_178_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	178	0		29	10	S5810_178_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	178	0		29	10	S5810_178_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					86.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	179	0		29	10	S5810_179_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	179	0		29	10	S5810_179_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	179	0		29	10	S5810_179_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	179	0		29	10	S5810_179_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	179	0		29	10	S5810_179_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	179	0		29	10	S5810_179_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	180	0		29	10	S5810_180_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					38.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	180	0		29	10	S5810_180_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	180	0		29	10	S5810_180_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	180	0		29	10	S5810_180_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	180	0		29	10	S5810_180_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	180	0		29	10	S5810_180_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	182	0		29	10	S5810_182_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	182	0		29	10	S5810_182_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					35.00	24	24	24																												24	24	24					24	24	24				24			24	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	182	0		29	10	S5810_182_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.00	44	44	44																												44	44	44					44	44	44				44			44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	182	0		29	10	S5810_182_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	182	0		29	10	S5810_182_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	182	0		29	10	S5810_182_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	183	0		29	10	S5810_183_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					37.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	183	0		29	10	S5810_183_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	183	0		29	10	S5810_183_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	183	0		29	10	S5810_183_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	183	0		29	10	S5810_183_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	183	0		29	10	S5810_183_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	184	0		29	10	S5810_184_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	184	0		29	10	S5810_184_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					37.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	184	0		29	10	S5810_184_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					78.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	184	0		29	10	S5810_184_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	184	0		29	10	S5810_184_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	184	0		29	10	S5810_184_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			12.00	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	185	0		29	10	S5810_185_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	185	0		29	10	S5810_185_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					37.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	185	0		29	10	S5810_185_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	185	0		29	10	S5810_185_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	185	0		29	10	S5810_185_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					77.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	185	0		29	10	S5810_185_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	186	0		29	10	S5810_186_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	186	0		29	10	S5810_186_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					82.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	186	0		29	10	S5810_186_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	186	0		29	10	S5810_186_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00					3.00			.09	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	186	0		29	10	S5810_186_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	186	0		29	10	S5810_186_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	187	0		29	10	S5810_187_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	187	0		29	10	S5810_187_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	187	0		29	10	S5810_187_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	187	0		29	10	S5810_187_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	187	0		29	10	S5810_187_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	187	0		29	10	S5810_187_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	188	0		29	10	S5810_188_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	188	0		29	10	S5810_188_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.00	24	24	24																												24	24	24					24	24	24				24			24	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	188	0		29	10	S5810_188_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					80.00	43	43	43																												43	43	43					43	43	43				43			43	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	188	0		29	10	S5810_188_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	188	0		29	10	S5810_188_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	188	0		29	10	S5810_188_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	189	0		29	10	S5810_189_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	189	0		29	10	S5810_189_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	189	0		29	10	S5810_189_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	189	0		29	10	S5810_189_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					34.00	23	23	23																												23	23	23					23	23	23				23			23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	189	0		29	10	S5810_189_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	189	0		29	10	S5810_189_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	190	0		29	10	S5810_190_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	190	0		29	10	S5810_190_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	190	0		29	10	S5810_190_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	190	0		29	10	S5810_190_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					81.00	44	44	44																												44	44	44					44	44	44				44			44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	190	0		29	10	S5810_190_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	190	0		29	10	S5810_190_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					39.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	191	0		29	10	S5810_191_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	191	0		29	10	S5810_191_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	191	0		29	10	S5810_191_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					91.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	191	0		29	10	S5810_191_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					35.00	24	24	24																												24	24	24					24	24	24				24			24	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	191	0		29	10	S5810_191_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	191	0		29	10	S5810_191_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	192	0		29	10	S5810_192_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	192	0		29	10	S5810_192_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					39.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	192	0		29	10	S5810_192_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					83.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	192	0		29	10	S5810_192_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	192	0		29	10	S5810_192_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	192	0		29	10	S5810_192_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	193	0		29	10	S5810_193_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	193	0		29	10	S5810_193_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	193	0		29	10	S5810_193_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					81.00	44	44	44																												44	44	44					44	44	44				44			44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	193	0		29	10	S5810_193_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					39.00	24	24	24																												24	24	24					24	24	24				24			24	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	193	0		29	10	S5810_193_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	193	0		29	10	S5810_193_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	194	0		29	10	S5810_194_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	194	0		29	10	S5810_194_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	194	0		29	10	S5810_194_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					82.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	194	0		29	10	S5810_194_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					37.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	194	0		29	10	S5810_194_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	194	0		29	10	S5810_194_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	195	0		29	10	S5810_195_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	195	0		29	10	S5810_195_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	195	0		29	10	S5810_195_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					83.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	195	0		29	10	S5810_195_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					37.00	24	24	24																												24	24	24					24	24	24				24			24	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	195	0		29	10	S5810_195_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	195	0		29	10	S5810_195_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	197	0		29	10	S5810_197_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	197	0		29	10	S5810_197_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	197	0		29	10	S5810_197_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					88.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	197	0		29	10	S5810_197_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					37.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	197	0		29	10	S5810_197_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	197	0		29	10	S5810_197_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	198	0		29	10	S5810_198_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00					3.00			.09	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	198	0		29	10	S5810_198_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					35.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	198	0		29	10	S5810_198_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					82.00	44	44	44																												44	44	44					44	44	44				44			44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	198	0		29	10	S5810_198_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	198	0		29	10	S5810_198_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	198	0		29	10	S5810_198_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	199	0		29	10	S5810_199_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	199	0		29	10	S5810_199_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	199	0		29	10	S5810_199_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					86.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	199	0		29	10	S5810_199_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	199	0		29	10	S5810_199_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	199	0		29	10	S5810_199_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	200	0		29	10	S5810_200_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	200	0		29	10	S5810_200_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					33.00	24	24	24																												24	24	24					24	24	24				24			24	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	200	0		29	10	S5810_200_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	200	0		29	10	S5810_200_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	200	0		29	10	S5810_200_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	200	0		29	10	S5810_200_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					80.00	44	44	44																												44	44	44					44	44	44				44			44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	201	0		29	10	S5810_201_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	201	0		29	10	S5810_201_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	201	0		29	10	S5810_201_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	201	0		29	10	S5810_201_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					79.00	44	44	44																												44	44	44					44	44	44				44			44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	201	0		29	10	S5810_201_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					33.00	24	24	24																												24	24	24					24	24	24				24			24	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	201	0		29	10	S5810_201_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	202	0		29	10	S5810_202_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	202	0		29	10	S5810_202_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.10	3.00	6.00	9.00																												.10	3.00	6.00	6.00				.10	3.00	6.00	9.00					3.00			.09	3.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	202	0		29	10	S5810_202_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	202	0		29	10	S5810_202_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					36.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	202	0		29	10	S5810_202_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					90.00	44	44	44																												44	44	44					44	44	44				44			44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	202	0		29	10	S5810_202_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	204	0		29	10	S5810_204_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	204	0		29	10	S5810_204_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	204	0		29	10	S5810_204_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	204	0		29	10	S5810_204_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					35.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	204	0		29	10	S5810_204_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					72.00	44	44	44																												44	44	44					44	44	44				44			44	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	204	0		29	10	S5810_204_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	239	0		29	10	S5810_239_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	239	0		29	10	S5810_239_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.12	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	239	0		29	10	S5810_239_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	239	0		29	10	S5810_239_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	239	0		29	10	S5810_239_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					95.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	239	0		29	10	S5810_239_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					38.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	240	0		29	10	S5810_240_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	240	0		29	10	S5810_240_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					37.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	240	0		29	10	S5810_240_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.16	5.00	10.00	15.00																												.16	5.00	10.00	10.00				.16	5.00	10.00	15.00					5.00			.16	5.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	240	0		29	10	S5810_240_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					82.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	240	0		29	10	S5810_240_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	240	0		29	10	S5810_240_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.13	4.00	8.00	12.00																												.13	4.00	8.00	8.00				.13	4.00	8.00	12.00					4.00			.13	4.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	241	0		29	10	S5810_241_0	2	3	Non-Preferred Brand	1	4	110000	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					83.00	45	45	45																												45	45	45					45	45	45				45			45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	241	0		29	10	S5810_241_0	2	2	Preferred Brand	1	4	010001	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					37.00	25	25	25																												25	25	25					25	25	25				25			25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	241	0		29	10	S5810_241_0	2	1	Generic	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.20	6.00	12.00	18.00																												.20	6.00	12.00	12.00				.20	6.00	12.00	18.00					6.00			.19	6.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	241	0		29	10	S5810_241_0	2	4	Specialty Tier	1	4	010010	1	1	111		10		111	1	30	60	90				1				30	60	90		10	31					1.00	33	33	33																												33	33	33					33	33	33				33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5810	241	0		29	10	S5810_241_0	2	5	Select Care Drugs	3	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.06	2.00	4.00	6.00																												.06	2.00	4.00	4.00				.06	2.00	4.00	6.00					2.00			.06	2.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5810	241	0		29	10	S5810_241_0	2	5	Select Care Drugs	1	4	010000	1	2	111		10		111	1	30	60	90				1				30	60	90		10	31	.03	1.00	2.00	3.00																												.03	1.00	2.00	2.00				.03	1.00	2.00	3.00					1.00			.03	1.00		Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5820	001	0		29	10	S5820_001_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													534.00	33		33					534.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.36	41.00		123.00															115.00							123.00				41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.26	8.00		24.00															5.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.33	10.00		30.00															7.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													535.00	33		33					535.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.36	41.00		123.00															115.00							123.00				41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.16	5.00		15.00															0.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.36	41.00		123.00															115.00							123.00				41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.30	9.00		27.00															6.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.16	5.00		15.00															0.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													586.00	33		33					586.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													527.00	33		33					527.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.23	7.00		21.00															0.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.36	11.00		33.00															6.00							33.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													559.00	33		33					559.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.66	80.00		240.00					3.16	95.00		285.00															235.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.30	39.00		117.00					1.50	45.00		135.00															112.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.23	7.00		21.00															0.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.36	11.00		33.00															6.00							33.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													523.00	33		33					523.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.23	7.00		21.00															0.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.36	11.00		33.00															6.00							33.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.30	39.00		117.00					1.50	45.00		135.00															112.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.43	43.00		129.00															115.00							129.00				43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.66	80.00		240.00					3.16	95.00		285.00															235.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													562.00	33		33					562.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.33	10.00		30.00															7.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.16	5.00		15.00															0.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.23	7.00		21.00															0.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.40	12.00		36.00															6.00							36.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.66	80.00		240.00					3.16	95.00		285.00															235.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													608.00	33		33					608.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.16	5.00		15.00															0.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.33	10.00		30.00															7.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.36	41.00		123.00															115.00							123.00				41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													557.00	33		33					557.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.40	12.00		36.00															7.00							36.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.26	8.00		24.00															0.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													558.00	33		33					558.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.30	9.00		27.00															6.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.16	5.00		15.00															0.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.36	41.00		123.00															115.00							123.00				41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													552.00	33		33					552.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.26	8.00		24.00															0.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.40	12.00		36.00															7.00							36.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.66	80.00		240.00					3.16	95.00		285.00															235.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													549.00	33		33					549.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.36	11.00		33.00															6.00							33.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.23	7.00		21.00															0.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													558.00	33		33					558.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													559.00	33		33					559.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.36	41.00		123.00															115.00							123.00				41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.33	10.00		30.00															7.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.20	6.00		18.00															0.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.26	8.00		24.00															0.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													512.00	33		33					512.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.40	12.00		36.00															7.00							36.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													509.00	33		33					509.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.36	41.00		123.00															115.00							123.00				41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.30	9.00		27.00															6.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.16	5.00		15.00															0.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.23	7.00		21.00															0.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													544.00	33		33					544.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.36	11.00		33.00															6.00							33.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													615.00	33		33					615.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.36	41.00		123.00															115.00							123.00				41.00				1.32	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.36	11.00		33.00															6.00							33.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.20	6.00		18.00															0.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.16	5.00		15.00															0.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.30	9.00		27.00															6.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													594.00	33		33					594.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.30	9.00		27.00															6.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.16	5.00		15.00															0.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.46	44.00		132.00															115.00							132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.00	90.00		270.00															250.00							270.00				90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													553.00	33		33					553.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.23	7.00		21.00															0.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.33	10.00		30.00															7.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													580.00	33		33					580.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.33	10.00		30.00															6.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.20	6.00		18.00															0.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													570.00	33		33					570.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.23	7.00		21.00															0.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.36	11.00		33.00															6.00							33.00				11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													595.00	33		33					595.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.16	5.00		15.00															0.00							15.00				5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.26	8.00		24.00															5.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													510.00	33		33					510.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.26	8.00		24.00															0.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.40	12.00		36.00															7.00							36.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													492.00	33		33					492.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.26	8.00		24.00															0.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.40	12.00		36.00															7.00							36.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													497.00	33		33					497.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													537.00	33		33					537.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.40	12.00		36.00															7.00							36.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.26	8.00		24.00															0.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.40	12.00		36.00															7.00							36.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.26	8.00		24.00															0.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													542.00	33		33					542.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.20	6.00		18.00															0.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													508.00	33		33					508.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.30	9.00		27.00															5.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.20	6.00		18.00															0.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.30	9.00		27.00															6.00							27.00				9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													551.00	33		33					551.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.20	6.00		18.00															0.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.33	10.00		30.00															5.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													564.00	33		33					564.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													509.00	33		33					509.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.23	7.00		21.00					.40	12.00		36.00															7.00							36.00				12.00				.38	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.26	8.00		24.00															0.00							24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	3	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	3	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.50	45.00		135.00															115.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	3	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.20	6.00		18.00					.33	10.00		30.00															6.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	3	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.10	3.00		9.00					.23	7.00		21.00															0.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	3	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													516.00	33		33					516.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	.50	15.00		45.00																								45.00																		15.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	4	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		30.00																								30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	4	3	Preferred Brand	1	3	010001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	4	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				1			90				30		31					703.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	4	3	Preferred Brand	1	3	010001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	.36	11.00		33.00																								33.00																		11.00				.35	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	4	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	.23	7.00		21.00																								21.00																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	4	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				1			90				30		31					611.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	4	3	Preferred Brand	1	3	010001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	.66	20.00		60.00																								60.00																		20.00				.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	4	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	.33	10.00		30.00																								30.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	4	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				1			90				30		31					553.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	4	1	Preferred Generic	1	3	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.33	10.00		30.00															6.00							30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	4	2	Non-Preferred Generic	1	3	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.63	19.00		57.00															15.00							57.00				19.00				.61	19.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	4	3	Preferred Brand	1	3	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.43	43.00		129.00					1.50	45.00		135.00															124.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	4	4	Non-Preferred Brand	1	3	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.83	85.00		255.00					3.16	95.00		285.00															250.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	4	5	Specialty Tier	1	3	010010	1	1		110	01		100	1				30		90	1						90	30		31													1056.00	33		33					1056.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	4	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	.30	9.00		27.00																								27.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	.56	17.00		51.00																								51.00																		17.00				.54	17.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	4	4	Non-Preferred Brand	1	3	100100	1	2	110		01	100		1	30		90				1			90				30		31	3.16	95.00		285.00																								285.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	4	3	Preferred Brand	1	3	010001	1	2	110		01	100		1	30		90				1			90				30		31	1.50	45.00		135.00																								135.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	4	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				1			90				30		31					674.00	33		33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5840	002	0		29	10	S5840_002_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	2.00	60.00		180.00																								120.00																		60.00				1.94	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5840	002	0		29	10	S5840_002_0	9	5	Specialty Tier	1	4	010010	1	1	110		01			1	30		90				2							30		31						25		25																																								25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5840	002	0		29	10	S5840_002_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.13	4.00		12.00																								8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5840	002	0		29	10	S5840_002_0	9	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.27	8.00		24.00																								16.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5840	002	0		29	10	S5840_002_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	.13	4.00		12.00																								8.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5840	002	0		29	10	S5840_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	.27	8.00		24.00																								16.00																		8.00				.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5840	002	0		29	10	S5840_002_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.00	30.00		90.00																								60.00																		30.00				.97	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5877	004	0		29	10	S5877_004_0	3	1	Preferred Generic	1	2	001000	1	2	110		10	100		1	34		90				2			90					29	34	0.06	2.00		6.00																								6.00																			2.00			0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S5877	004	0		29	10	S5877_004_0	3	2	Non-Preferred Generic	1	2	000100	1	2	110		10	100		1	34		90				2			90					29	34	0.35	12.00		36.00																								36.00																			12.00			0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S5877	004	0		29	10	S5877_004_0	3	3	Preferred Brand	1	2	000001	1	2	110		10	100		1	34		90				2			90					29	34	1.32	45.00		135.00																								135.00																			45.00			1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S5877	004	0		29	10	S5877_004_0	3	4	Specialty Tier	1	2	010010	1	1	110		10	100		1	34		90				2			90					29	34					1.00	25		25																							25																		25			25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S5877	007	0		29	10	S5877_007_0	3	1	Generic	1	4	010000	1	1	110		10	100		1	34		90				2			90					29	34					2.00	10		10																							10																		10			10	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5877	007	0		29	10	S5877_007_0	3	2	Preferred Brand	1	4	000001	1	1	110		10	100		1	34		90				2			90					29	34					35.00	20		20																							20																		20			20	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5877	007	0		29	10	S5877_007_0	3	3	Non-Preferred Brand	1	4	100000	1	1	110		10	100		1	34		90				2			90					29	34					31.00	40		40																							40																		40			40	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5877	007	0		29	10	S5877_007_0	3	4	Specialty Tier	1	4	010010	1	1	110		10	100		1	34		90				2			90					29	34					1.00	33		33																							33																		33			33	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	001	0		29	10	S5884_001_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	001	0		29	10	S5884_001_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	5	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	5	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	5	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	5	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	5	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	002	0		29	10	S5884_002_0	5	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	004	0		29	10	S5884_004_0	4	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	4	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	004	0		29	10	S5884_004_0	4	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	004	0		29	10	S5884_004_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	005	0		29	10	S5884_005_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	005	0		29	10	S5884_005_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	008	0		29	10	S5884_008_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	008	0		29	10	S5884_008_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	009	0		29	10	S5884_009_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	010	0		29	10	S5884_010_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	010	0		29	10	S5884_010_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	010	0		29	10	S5884_010_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	015	0		29	10	S5884_015_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	015	0		29	10	S5884_015_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	019	0		29	10	S5884_019_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	019	0		29	10	S5884_019_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	020	0		29	10	S5884_020_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	020	0		29	10	S5884_020_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	021	0		29	10	S5884_021_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	022	0		29	10	S5884_022_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	022	0		29	10	S5884_022_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	022	0		29	10	S5884_022_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	024	0		29	10	S5884_024_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	024	0		29	10	S5884_024_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	028	0		29	10	S5884_028_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	028	0		29	10	S5884_028_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	4	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	4	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	030	0		29	10	S5884_030_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	4	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	030	0		29	10	S5884_030_0	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	062	0		29	10	S5884_062_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	062	0		29	10	S5884_062_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	065	0		29	10	S5884_065_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	065	0		29	10	S5884_065_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	066	0		29	10	S5884_066_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	071	0		29	10	S5884_071_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	071	0		29	10	S5884_071_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	072	0		29	10	S5884_072_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	072	0		29	10	S5884_072_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	072	0		29	10	S5884_072_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	073	0		29	10	S5884_073_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	073	0		29	10	S5884_073_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	4	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	074	0		29	10	S5884_074_0	4	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	074	0		29	10	S5884_074_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	4	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	076	0		29	10	S5884_076_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	076	0		29	10	S5884_076_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	077	0		29	10	S5884_077_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	078	0		29	10	S5884_078_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	078	0		29	10	S5884_078_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	083	0		29	10	S5884_083_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	083	0		29	10	S5884_083_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	083	0		29	10	S5884_083_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	4	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	085	0		29	10	S5884_085_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	4	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	4	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	086	0		29	10	S5884_086_0	4	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	086	0		29	10	S5884_086_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	4	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	4	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	087	0		29	10	S5884_087_0	4	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	4	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	087	0		29	10	S5884_087_0	4	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	087	0		29	10	S5884_087_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	089	0		29	10	S5884_089_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	092	0		29	10	S5884_092_0	4	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	4	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	092	0		29	10	S5884_092_0	4	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	093	0		29	10	S5884_093_0	4	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.46	44.00		132.00					1.50	45.00		135.00												1.46	44.00		122.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									.13	4.00		12.00					0.33	10.00		30.00												.13	4.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.13	94.00		282.00					3.16	95.00		285.00												3.13	94.00		272.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	4	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.13	94.00		282.00					3.16	95.00		285.00												3.13	94.00		272.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	093	0		29	10	S5884_093_0	4	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.46	44.00		132.00					1.50	45.00		135.00												1.46	44.00		122.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	093	0		29	10	S5884_093_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.16	5.00		15.00					0.33	10.00		30.00												0.16	5.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	3	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	3	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									1.40	42.00		126.00					1.50	45.00		135.00												1.40	42.00		116.00				1.50	45.00		135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	094	0		29	10	S5884_094_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	33							1.00	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	3	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31									3.06	92.00		276.00					3.16	95.00		285.00												3.06	92.00		266.00				3.16	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	101	0		29	10	S5884_101_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													40.00	35		35					47.00	40		40												35		35					40		40			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					26.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.23	7.00		21.00												0.06	2.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													43.00	35		35					49.00	37		37												35		35					37		37			37				37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	5	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	5	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.13	4.00		12.00												0.06	2.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.13	4.00		12.00												0.03	1.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													33.00	35		35					47.00	41		41												35		35					41		41			41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													36.00	35		35					47.00	41		41												35		35					41		41			41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.13	4.00		12.00												0.06	2.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					26.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													37.00	35		35					43.00	39		39												35		35					39		39			39				39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													17.00	20		20					22.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													29.00	35		35					39.00	42		42												35		35					42		42			42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													31.00	35		35					41.00	41		41												35		35					41		41			41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.26	8.00		24.00												0.06	2.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													31.00	35		35					42.00	43		43												35		35					43		43			43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.13	4.00		12.00												0.03	1.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.23	7.00		21.00												0.06	2.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					23.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													32.00	35		35					45.00	42		42												35		35					42		42			42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													41.00	35		35					53.00	41		41												35		35					41		41			41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.13	4.00		12.00												0.06	2.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.13	4.00		12.00												0.06	2.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					23.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													43.00	35		35					52.00	39		39												35		35					39		39			39				39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													38.00	35		35					45.00	39		39												35		35					39		39			39				39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.13	4.00		12.00												0.06	2.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													34.00	35		35					43.00	42		42												35		35					42		42			42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													17.00	20		20					23.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.13	4.00		12.00												0.06	2.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													36.00	35		35					42.00	37		37												35		35					37		37			37				37	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.06	2.00		6.00												0.03	1.00		0.00				0.06	2.00		6.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													49.00	35		35					56.00	39		39												35		35					39		39			39				39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	20		20					32.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.13	4.00		12.00												0.06	2.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.10	3.00		9.00												0.06	2.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					23.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.06	2.00		6.00												0.03	1.00		0.00				0.06	2.00		6.00				2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													35.00	35		35					42.00	39		39												35		35					39		39			39				39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.13	4.00		12.00												0.06	2.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													21.00	20		20					28.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													42.00	35		35					51.00	39		39												35		35					39		39			39				39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.43	13.00		39.00												0.06	2.00		0.00				0.43	13.00		39.00				13.00				0.41	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.30	9.00		27.00												0.03	1.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													27.00	35		35					42.00	50		50												35		35					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.13	4.00		12.00												0.06	2.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													36.00	35		35					49.00	43		43												35		35					43		43			43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													26.00	35		35					41.00	50		50												35		35					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					26.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.50	15.00		45.00												0.06	2.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.30	9.00		27.00												0.03	1.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.23	7.00		21.00												0.06	2.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													32.00	35		35					42.00	44		44												35		35					44		44			44				44	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.16	5.00		15.00												0.06	2.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					23.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													36.00	35		35					48.00	40		40												35		35					40		40			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													37.00	35		35					47.00	39		39												35		35					39		39			39				39	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.13	4.00		12.00												0.03	1.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.23	7.00		21.00												0.06	2.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													32.00	35		35					44.00	40		40												35		35					40		40			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.26	8.00		24.00												0.06	2.00		0.00				0.26	8.00		24.00				8.00				0.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													33.00	35		35					48.00	43		43												35		35					43		43			43				43	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					23.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													37.00	35		35					48.00	40		40												35		35					40		40			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.16	5.00		15.00												0.06	2.00		0.00				0.16	5.00		15.00				5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													27.00	35		35					43.00	45		45												35		35					45		45			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.33	10.00		30.00												0.06	2.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.20	6.00		18.00												0.03	1.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													31.00	35		35					43.00	44		44												35		35					44		44			44				44	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.50	15.00		45.00												0.06	2.00		0.00				0.50	15.00		45.00				15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													26.00	35		35					43.00	50		50												35		35					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.30	9.00		27.00												0.03	1.00		0.00				0.30	9.00		27.00				9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					26.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													33.00	35		35					42.00	40		40												35		35					40		40			40				40	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					23.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.20	6.00		18.00												0.06	2.00		0.00				0.20	6.00		18.00				6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.13	4.00		12.00												0.06	2.00		0.00				0.13	4.00		12.00				4.00				0.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					23.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													39.00	35		35					50.00	41		41												35		35					41		41			41				41	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.23	7.00		21.00												0.06	2.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													25.00	35		35					39.00	47		47												35		35					47		47			47				47	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	4	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.10	3.00		9.00												0.03	1.00		0.00				0.10	3.00		9.00				3.00				0.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	4	2	Non-Preferred Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.06	2.00		6.00					0.23	7.00		21.00												0.06	2.00		0.00				0.23	7.00		21.00				7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	4	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													17.00	20		20					22.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	4	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													35.00	35		35					47.00	42		42												35		35					42		42			42				42	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	4	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													21.00	20		20					27.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													38.00	39		39					50.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													34.00	39		39					45.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	4	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					26.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	4	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													39.00	39		39					52.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					26.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													21.00	20		20					27.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													29.00	39		39					39.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													33.00	39		39					44.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					26.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													29.00	39		39					39.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													21.00	20		20					26.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													30.00	39		39					41.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													30.00	39		39					40.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					26.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													33.00	39		39					44.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													34.00	39		39					46.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													28.00	39		39					38.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													29.00	39		39					38.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													33.00	39		39					44.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													29.00	39		39					40.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													30.00	39		39					41.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													21.00	20		20					27.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													21.00	20		20					27.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													31.00	39		39					41.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					26.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													33.00	39		39					44.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													29.00	39		39					39.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													31.00	39		39					41.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													30.00	39		39					39.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													21.00	20		20					27.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													31.00	39		39					41.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													32.00	39		39					44.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					25.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													30.00	39		39					40.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													20.00	20		20					26.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													33.00	39		39					44.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													29.00	39		39					39.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													22.00	20		20					28.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													37.00	39		39					50.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													26.00	39		39					34.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					23.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													19.00	20		20					24.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													33.00	39		39					45.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					23.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													30.00	39		39					40.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					23.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													32.00	39		39					43.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													32.00	39		39					43.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													18.00	20		20					23.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													28.00	20		20					35.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													47.00	39		39					65.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	3	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31													31.00	39		39					41.00	50		50												39		39					50		50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	3	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31													21.00	20		20					27.00	25		25												20		20					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	3	2	Non-Preferred Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31									0.13	4.00		12.00					1.10	33.00		99.00												0.13	4.00		0.00				1.10	33.00		99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	3	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31									0.03	1.00		3.00					0.33	10.00		30.00												0.03	1.00		0.00				0.33	10.00		30.00				10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	3	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31													1.00	25							1.00	25														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	8	5	Specialty Tier	1	3	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													1602.51	33		33					1602.51	33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	8	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.03	94.00		282.00					3.06	95.00		285.00					2.87	89.00		267.00																		95.00				3.03	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	8	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.38	43.00		129.00					1.45	45.00		135.00					1.25	39.00		117.00																		45.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	8	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									1.00	31.00		93.00					1.06	33.00		99.00					1.06	33.00		99.00																		33.00				1.00	31.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	8	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.25	8.00		24.00					.32	10.00		30.00					.32	10.00		30.00																		10.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5	2	Non-Preferred Generic	3	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.32	10.00		30.00					.38	12.00		36.00					.38	12.00		36.00																		12.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5904	002	0		29	10	S5904_002_0	5	5	Specialty Tier	3	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													1602.51	33		33					1602.51	33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
S5904	002	0		29	10	S5904_002_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.25	8.00		24.00					.25	8.00		24.00																		8.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5904	002	0		29	10	S5904_002_0	5	5	Specialty Tier	1	4	101101	1	1		110	01	110		1				31		90	1	31		90				31		31													1602.51	33		33					1602.51	33		33					33		33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				31		90	1	31		90				31		31									3.03	94.00		282.00					3.06	95.00		285.00					2.80	87.00		261.00																		95.00				3.03	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.38	43.00		129.00					1.45	45.00		135.00					1.16	36.00		108.00																		45.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.32	10.00		30.00					.38	12.00		36.00					.38	12.00		36.00																		12.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.09	3.00		9.00					.25	8.00		24.00					.25	8.00		24.00																		8.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5907	001	0		29	10	S5907_001_0	10	5	Specialty Tier	1	2	100100	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	25		25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5907	001	0		29	10	S5907_001_0	10	1	Preferred Generic	1	2	001000	1	2		110	01	100		1				30		90	1			90				30		31									.17	5.00		15.00					.23	7.00		21.00								10.00																		7.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5907	001	0		29	10	S5907_001_0	10	2	Non-Preferred Generic	1	2	000100	1	2		110	01	100		1				30		90	1			90				30		31									.33	10.00		30.00					.40	12.00		36.00								20.00																		12.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5907	001	0		29	10	S5907_001_0	10	3	Preferred Brand	1	2	000001	1	2		110	01	100		1				30		90	1			90				30		31									.67	20.00		60.00					.83	25.00		75.00								40.00																		25.00				.65	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5907	001	0		29	10	S5907_001_0	10	4	Non-Preferred Brand	1	2	100000	1	3		110	01	100		1				30		90	1			90				30		31									1.16	35.00		105.00	1.00	25		25	1.33	40.00		120.00	1.00	25		25				70.00			25															40.00		25		1.13	35.00	25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5907	002	0		29	10	S5907_002_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.13	4.00		12.00					.20	6.00		18.00								8.00																		6.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5907	002	0		29	10	S5907_002_0	9	2	Non-Preferred Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.50	15.00		45.00					.67	20.00		60.00								30.00																		20.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5907	002	0		29	10	S5907_002_0	9	5	Specialty Tier	1	4	100100	1	1		110	01	100		1				30		90	1			90				30		31													1.00	25		25					1.00	33		33							25																	33				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5907	002	0		29	10	S5907_002_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31									.13	4.00		12.00					.20	6.00		18.00								8.00																		6.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5907	002	0		29	10	S5907_002_0	9	2	Non-Preferred Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31									.50	15.00		45.00					.66	20.00		60.00								30.00																		20.00				.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5907	002	0		29	10	S5907_002_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31									1.17	35.00		105.00					1.33	40.00		120.00								70.00																		40.00				1.13	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5907	002	0		29	10	S5907_002_0	9	4	Non-Preferred Brand	1	4	100000	1	3		110	01	100		1				30		90	1			90				30		31									1.33	40.00		120.00	1.00	25		25	1.50	45.00		135.00	1.00	25		25				80.00			25															45.00		25		1.29	40.00	25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	4	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					431.00	29																							29																			29				29	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	4	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	4	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	4	2	Non-Preferred Generic	1	3	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	4	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					530.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00	90.00		270.00																					3.00	90.00		225.00																		90.00				2.90	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	1.50	45.00		135.00																					1.50	45.00		112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	1.10	33.00		99.00																					1.10	33.00		66.00																		33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5916	002	0		29	10	S5916_002_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	.16	5.00		15.00																					0.16	5.00		10.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	003	0		29	10	S5921_003_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									.90	27.00		81.00					1.50	45.00		135.00															66.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	003	0		29	10	S5921_003_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	003	0		29	10	S5921_003_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	003	0		29	10	S5921_003_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	003	0		29	10	S5921_003_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	003	0		29	10	S5921_003_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	003	0		29	10	S5921_003_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													565.00	33		33					565.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	003	0		29	10	S5921_003_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									.90	27.00		81.00					1.50	45.00		135.00															66.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	003	0		29	10	S5921_003_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	003	0		29	10	S5921_003_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													617.00	33		33					617.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	013	0		29	10	S5921_013_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													586.00	33		33					586.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	013	0		29	10	S5921_013_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	013	0		29	10	S5921_013_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	013	0		29	10	S5921_013_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	013	0		29	10	S5921_013_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	013	0		29	10	S5921_013_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													531.00	33		33					531.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	013	0		29	10	S5921_013_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	013	0		29	10	S5921_013_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	013	0		29	10	S5921_013_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	013	0		29	10	S5921_013_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	023	0		29	10	S5921_023_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	023	0		29	10	S5921_023_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									.90	27.00		81.00					1.50	45.00		135.00															66.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	023	0		29	10	S5921_023_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	023	0		29	10	S5921_023_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	023	0		29	10	S5921_023_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													590.00	33		33					590.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	023	0		29	10	S5921_023_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									.90	27.00		81.00					1.50	45.00		135.00															66.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	023	0		29	10	S5921_023_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	023	0		29	10	S5921_023_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	023	0		29	10	S5921_023_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	023	0		29	10	S5921_023_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													529.00	33		33					529.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	033	0		29	10	S5921_033_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	033	0		29	10	S5921_033_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	033	0		29	10	S5921_033_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	033	0		29	10	S5921_033_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	033	0		29	10	S5921_033_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													405.00	33		33					405.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	033	0		29	10	S5921_033_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	033	0		29	10	S5921_033_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	033	0		29	10	S5921_033_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	033	0		29	10	S5921_033_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	033	0		29	10	S5921_033_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													706.00	33		33					706.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	043	0		29	10	S5921_043_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	043	0		29	10	S5921_043_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	043	0		29	10	S5921_043_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	043	0		29	10	S5921_043_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	043	0		29	10	S5921_043_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													728.00	33		33					728.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	043	0		29	10	S5921_043_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	043	0		29	10	S5921_043_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	043	0		29	10	S5921_043_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	043	0		29	10	S5921_043_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	043	0		29	10	S5921_043_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													554.00	33		33					554.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	053	0		29	10	S5921_053_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	053	0		29	10	S5921_053_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	053	0		29	10	S5921_053_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	053	0		29	10	S5921_053_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	053	0		29	10	S5921_053_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	053	0		29	10	S5921_053_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	053	0		29	10	S5921_053_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	053	0		29	10	S5921_053_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	053	0		29	10	S5921_053_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													507.00	33		33					507.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	053	0		29	10	S5921_053_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													610.00	33		33					610.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	063	0		29	10	S5921_063_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													625.00	33		33					625.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	063	0		29	10	S5921_063_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	063	0		29	10	S5921_063_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	063	0		29	10	S5921_063_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	063	0		29	10	S5921_063_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	063	0		29	10	S5921_063_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	063	0		29	10	S5921_063_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	063	0		29	10	S5921_063_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													472.00	33		33					472.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	063	0		29	10	S5921_063_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	063	0		29	10	S5921_063_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	073	0		29	10	S5921_073_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	073	0		29	10	S5921_073_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	073	0		29	10	S5921_073_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													656.00	33		33					656.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	073	0		29	10	S5921_073_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	073	0		29	10	S5921_073_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	073	0		29	10	S5921_073_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	073	0		29	10	S5921_073_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	073	0		29	10	S5921_073_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													649.00	33		33					649.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	073	0		29	10	S5921_073_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	073	0		29	10	S5921_073_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	083	0		29	10	S5921_083_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	083	0		29	10	S5921_083_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													654.00	33		33					654.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	083	0		29	10	S5921_083_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	083	0		29	10	S5921_083_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	083	0		29	10	S5921_083_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	083	0		29	10	S5921_083_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	083	0		29	10	S5921_083_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													668.00	33		33					668.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	083	0		29	10	S5921_083_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	083	0		29	10	S5921_083_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	083	0		29	10	S5921_083_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	093	0		29	10	S5921_093_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.50	75.00		225.00					3.16	95.00		285.00															210.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	093	0		29	10	S5921_093_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									.80	24.00		72.00					1.50	45.00		135.00															57.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	093	0		29	10	S5921_093_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	093	0		29	10	S5921_093_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	093	0		29	10	S5921_093_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													634.00	33		33					634.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	093	0		29	10	S5921_093_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.50	75.00		225.00					3.16	95.00		285.00															210.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	093	0		29	10	S5921_093_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													414.00	33		33					414.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	093	0		29	10	S5921_093_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									.80	24.00		72.00					1.50	45.00		135.00															57.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	093	0		29	10	S5921_093_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	093	0		29	10	S5921_093_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	103	0		29	10	S5921_103_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													607.00	33		33					607.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	103	0		29	10	S5921_103_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	103	0		29	10	S5921_103_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	103	0		29	10	S5921_103_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	103	0		29	10	S5921_103_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	103	0		29	10	S5921_103_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													530.00	33		33					530.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	103	0		29	10	S5921_103_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	103	0		29	10	S5921_103_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	103	0		29	10	S5921_103_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	103	0		29	10	S5921_103_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	113	0		29	10	S5921_113_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	113	0		29	10	S5921_113_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													494.00	33		33					494.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	113	0		29	10	S5921_113_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.00	60.00		180.00					3.16	95.00		285.00															165.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	113	0		29	10	S5921_113_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	113	0		29	10	S5921_113_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	113	0		29	10	S5921_113_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	113	0		29	10	S5921_113_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													494.00	33		33					494.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	113	0		29	10	S5921_113_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.00	60.00		180.00					3.16	95.00		285.00															165.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	113	0		29	10	S5921_113_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	113	0		29	10	S5921_113_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	123	0		29	10	S5921_123_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	123	0		29	10	S5921_123_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													714.00	33		33					714.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	123	0		29	10	S5921_123_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	123	0		29	10	S5921_123_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	123	0		29	10	S5921_123_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	123	0		29	10	S5921_123_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	123	0		29	10	S5921_123_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													371.00	33		33					371.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	123	0		29	10	S5921_123_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	123	0		29	10	S5921_123_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	123	0		29	10	S5921_123_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	133	0		29	10	S5921_133_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	133	0		29	10	S5921_133_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	133	0		29	10	S5921_133_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	133	0		29	10	S5921_133_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	133	0		29	10	S5921_133_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	133	0		29	10	S5921_133_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	133	0		29	10	S5921_133_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													618.00	33		33					618.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	133	0		29	10	S5921_133_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													647.00	33		33					647.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	133	0		29	10	S5921_133_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	133	0		29	10	S5921_133_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	143	0		29	10	S5921_143_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	143	0		29	10	S5921_143_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	143	0		29	10	S5921_143_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													488.00	33		33					488.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	143	0		29	10	S5921_143_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	143	0		29	10	S5921_143_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	143	0		29	10	S5921_143_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	143	0		29	10	S5921_143_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	143	0		29	10	S5921_143_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													615.00	33		33					615.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	143	0		29	10	S5921_143_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	143	0		29	10	S5921_143_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	153	0		29	10	S5921_153_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	153	0		29	10	S5921_153_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	153	0		29	10	S5921_153_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	153	0		29	10	S5921_153_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	153	0		29	10	S5921_153_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													462.00	33		33					462.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	153	0		29	10	S5921_153_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	153	0		29	10	S5921_153_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	153	0		29	10	S5921_153_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	153	0		29	10	S5921_153_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	153	0		29	10	S5921_153_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													567.00	33		33					567.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	163	0		29	10	S5921_163_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	163	0		29	10	S5921_163_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	163	0		29	10	S5921_163_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	163	0		29	10	S5921_163_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.00	60.00		180.00					3.16	95.00		285.00															165.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	163	0		29	10	S5921_163_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													553.00	33		33					553.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	163	0		29	10	S5921_163_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	163	0		29	10	S5921_163_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	163	0		29	10	S5921_163_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	163	0		29	10	S5921_163_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.00	60.00		180.00					3.16	95.00		285.00															165.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	163	0		29	10	S5921_163_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													558.00	33		33					558.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	173	0		29	10	S5921_173_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													492.00	33		33					492.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	173	0		29	10	S5921_173_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	173	0		29	10	S5921_173_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	173	0		29	10	S5921_173_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									.90	27.00		81.00					1.50	45.00		135.00															66.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	173	0		29	10	S5921_173_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	173	0		29	10	S5921_173_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													611.00	33		33					611.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	173	0		29	10	S5921_173_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	173	0		29	10	S5921_173_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									.90	27.00		81.00					1.50	45.00		135.00															66.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	173	0		29	10	S5921_173_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	173	0		29	10	S5921_173_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	183	0		29	10	S5921_183_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	183	0		29	10	S5921_183_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													634.00	33		33					634.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	183	0		29	10	S5921_183_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	183	0		29	10	S5921_183_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	183	0		29	10	S5921_183_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	183	0		29	10	S5921_183_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	183	0		29	10	S5921_183_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													582.00	33		33					582.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	183	0		29	10	S5921_183_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	183	0		29	10	S5921_183_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	183	0		29	10	S5921_183_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	193	0		29	10	S5921_193_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													659.00	33		33					659.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	193	0		29	10	S5921_193_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	193	0		29	10	S5921_193_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	193	0		29	10	S5921_193_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	193	0		29	10	S5921_193_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	193	0		29	10	S5921_193_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													543.00	33		33					543.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	193	0		29	10	S5921_193_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	193	0		29	10	S5921_193_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	193	0		29	10	S5921_193_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	193	0		29	10	S5921_193_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	213	0		29	10	S5921_213_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	213	0		29	10	S5921_213_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	213	0		29	10	S5921_213_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	213	0		29	10	S5921_213_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	213	0		29	10	S5921_213_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													450.00	33		33					450.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	213	0		29	10	S5921_213_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	213	0		29	10	S5921_213_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	213	0		29	10	S5921_213_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	213	0		29	10	S5921_213_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	213	0		29	10	S5921_213_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													623.00	33		33					623.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	223	0		29	10	S5921_223_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	223	0		29	10	S5921_223_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	223	0		29	10	S5921_223_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	223	0		29	10	S5921_223_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	223	0		29	10	S5921_223_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													615.00	33		33					615.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	223	0		29	10	S5921_223_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	223	0		29	10	S5921_223_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	223	0		29	10	S5921_223_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	223	0		29	10	S5921_223_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	223	0		29	10	S5921_223_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													401.00	33		33					401.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	233	0		29	10	S5921_233_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	233	0		29	10	S5921_233_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													651.00	33		33					651.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	233	0		29	10	S5921_233_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	233	0		29	10	S5921_233_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	233	0		29	10	S5921_233_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	233	0		29	10	S5921_233_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	233	0		29	10	S5921_233_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													509.00	33		33					509.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	233	0		29	10	S5921_233_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	233	0		29	10	S5921_233_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	233	0		29	10	S5921_233_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	235	0		29	10	S5921_235_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	235	0		29	10	S5921_235_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													730.00	33		33					730.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	235	0		29	10	S5921_235_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	235	0		29	10	S5921_235_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	235	0		29	10	S5921_235_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	235	0		29	10	S5921_235_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	235	0		29	10	S5921_235_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													625.00	33		33					625.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	235	0		29	10	S5921_235_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	235	0		29	10	S5921_235_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	235	0		29	10	S5921_235_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	239	0		29	10	S5921_239_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													562.00	33		33					562.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	239	0		29	10	S5921_239_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	239	0		29	10	S5921_239_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	239	0		29	10	S5921_239_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													558.00	33		33					558.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	239	0		29	10	S5921_239_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	239	0		29	10	S5921_239_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	239	0		29	10	S5921_239_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	239	0		29	10	S5921_239_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	239	0		29	10	S5921_239_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	239	0		29	10	S5921_239_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	249	0		29	10	S5921_249_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													678.00	33		33					678.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	249	0		29	10	S5921_249_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	249	0		29	10	S5921_249_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									.90	27.00		81.00					1.50	45.00		135.00															66.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	249	0		29	10	S5921_249_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	249	0		29	10	S5921_249_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	249	0		29	10	S5921_249_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													654.00	33		33					654.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	249	0		29	10	S5921_249_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.13	4.00		12.00					.23	7.00		21.00															4.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	249	0		29	10	S5921_249_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	249	0		29	10	S5921_249_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.16	65.00		195.00					3.16	95.00		285.00															180.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	249	0		29	10	S5921_249_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									.90	27.00		81.00					1.50	45.00		135.00															66.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	263	0		29	10	S5921_263_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	263	0		29	10	S5921_263_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	263	0		29	10	S5921_263_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	263	0		29	10	S5921_263_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	263	0		29	10	S5921_263_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													558.00	33		33					558.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	263	0		29	10	S5921_263_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	263	0		29	10	S5921_263_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	263	0		29	10	S5921_263_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	263	0		29	10	S5921_263_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	263	0		29	10	S5921_263_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													655.00	33		33					655.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	273	0		29	10	S5921_273_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	273	0		29	10	S5921_273_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	273	0		29	10	S5921_273_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	273	0		29	10	S5921_273_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	273	0		29	10	S5921_273_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													496.00	33		33					496.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	273	0		29	10	S5921_273_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	273	0		29	10	S5921_273_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	273	0		29	10	S5921_273_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													627.00	33		33					627.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	273	0		29	10	S5921_273_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									2.33	70.00		210.00					3.16	95.00		285.00															195.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	273	0		29	10	S5921_273_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	293	0		29	10	S5921_293_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	293	0		29	10	S5921_293_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													540.00	33		33					540.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	293	0		29	10	S5921_293_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	293	0		29	10	S5921_293_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	293	0		29	10	S5921_293_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	293	0		29	10	S5921_293_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	293	0		29	10	S5921_293_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													542.00	33		33					542.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	293	0		29	10	S5921_293_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	293	0		29	10	S5921_293_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	293	0		29	10	S5921_293_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	303	0		29	10	S5921_303_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													455.00	33		33					455.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	303	0		29	10	S5921_303_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	303	0		29	10	S5921_303_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													649.00	33		33					649.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	303	0		29	10	S5921_303_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	303	0		29	10	S5921_303_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	303	0		29	10	S5921_303_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	303	0		29	10	S5921_303_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	303	0		29	10	S5921_303_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	303	0		29	10	S5921_303_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.83	55.00		165.00					3.16	95.00		285.00															150.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	303	0		29	10	S5921_303_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	323	0		29	10	S5921_323_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	323	0		29	10	S5921_323_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					3.16	95.00		285.00															135.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	323	0		29	10	S5921_323_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	323	0		29	10	S5921_323_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	323	0		29	10	S5921_323_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													785.00	33		33					785.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	323	0		29	10	S5921_323_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	323	0		29	10	S5921_323_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	323	0		29	10	S5921_323_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	323	0		29	10	S5921_323_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					3.16	95.00		285.00															135.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	323	0		29	10	S5921_323_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													541.00	33		33					541.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	333	0		29	10	S5921_333_0	4	2	Non-Preferred Generic	3	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	333	0		29	10	S5921_333_0	4	4	Non-Preferred Brand	3	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					3.16	95.00		285.00															135.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	333	0		29	10	S5921_333_0	4	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													464.00	33		33					464.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	333	0		29	10	S5921_333_0	4	4	Non-Preferred Brand	1	4	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.66	50.00		150.00					3.16	95.00		285.00															135.00							285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	333	0		29	10	S5921_333_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	333	0		29	10	S5921_333_0	4	3	Preferred Brand	3	4	010001	1	2		110	01		100	1				30		90	1						90	30		31									1.00	30.00		90.00					1.50	45.00		135.00															75.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	333	0		29	10	S5921_333_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															0.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	333	0		29	10	S5921_333_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31									.16	5.00		15.00					.23	7.00		21.00															5.00							21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	333	0		29	10	S5921_333_0	4	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.13	4.00		12.00															2.00							12.00				4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5921	333	0		29	10	S5921_333_0	4	5	Specialty Tier	3	4	010010	1	1		110	01		100	1				30		90	1						90	30		31													443.00	33		33					443.00	33		33														33							33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5921	348	0		29	10	S5921_348_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.66	50.00		150.00															105.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													351.00	25		25					351.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													382.00	25		25					382.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					.83	25.00		75.00															45.00							75.00				25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													376.00	25		25					376.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													391.00	25		25					391.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					.83	25.00		75.00															45.00							75.00				25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.50	45.00		135.00															90.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													373.00	25		25					373.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													357.00	25		25					357.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					.83	25.00		75.00															45.00							75.00				25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													400.00	25		25					400.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													380.00	25		25					380.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													366.00	25		25					366.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.83	25.00		75.00					1.00	30.00		90.00															60.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.50	45.00		135.00					2.00	60.00		180.00															120.00							180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					.83	25.00		75.00															45.00							75.00				25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													385.00	25		25					385.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													373.00	25		25					373.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.50	45.00		135.00															90.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													365.00	25		25					365.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													378.00	25		25					378.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					.83	25.00		75.00															45.00							75.00				25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													387.00	25		25					387.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													370.00	25		25					370.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.50	45.00		135.00															90.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													383.00	25		25					383.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					.83	25.00		75.00															45.00							75.00				25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													384.00	25		25					384.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.50	45.00		135.00															90.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													368.00	25		25					368.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													360.00	25		25					360.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													370.00	25		25					370.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.50	45.00		135.00															90.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													371.00	25		25					371.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.50	45.00		135.00															90.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													380.00	25		25					380.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													375.00	25		25					375.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.50	45.00		135.00															90.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					2.00	60.00		180.00															105.00							180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													352.00	25		25					352.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													350.00	25		25					350.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					2.00	60.00		180.00															105.00							180.00				60.00				1.93	60.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.83	55.00		165.00															105.00							165.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													354.00	25		25					354.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													376.00	25		25					376.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.50	45.00		135.00															90.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					.83	25.00		75.00															45.00							75.00				25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.50	45.00		135.00															90.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													393.00	25		25					393.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.66	50.00		150.00															105.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													353.00	25		25					353.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													356.00	25		25					356.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.33	40.00		120.00					1.83	55.00		165.00															105.00							165.00				55.00				1.77	55.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.50	45.00		135.00															90.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													368.00	25		25					368.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.50	45.00		135.00															90.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													381.00	25		25					381.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					.83	25.00		75.00															45.00							75.00				25.00				.80	25.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.66	50.00		150.00															90.00							150.00				50.00				1.61	50.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													418.00	25		25					418.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	3	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31									.03	1.00		3.00					.06	2.00		6.00															0.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	3	2	Non-Preferred Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31									.06	2.00		6.00					.10	3.00		9.00															2.00							9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	3	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31									.66	20.00		60.00					1.00	30.00		90.00															45.00							90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	3	4	Non-Preferred Brand	1	2	100100	1	2		110	01		100	1				30		90	1						90	30		31									1.16	35.00		105.00					1.50	45.00		135.00															90.00							135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	3	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31													378.00	25		25					378.00	25		25														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	5	1	Preferred Generic	1	3	001000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.09	3.00	6.00	9.00																												.09	3.00		6.00				.09	3.00		9.00				3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	5	5	Specialty Tier	1	3	010010	1	1	111		01		110	1	31	60	90				1				31		90	31		31						25	25	25																												25		25					25		25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	5	4	Non-Preferred Brand	1	3	110000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	3.06	95.00	190.00	285.00																												3.06	95.00		237.50				3.06	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	5	3	Preferred Brand	1	3	000001	1	2	111		01		110	1	31	60	90				1				31		90	31		31	1.41	44.00	88.00	132.00																												1.41	44.00		110.00				1.41	44.00		132.00				44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	5	2	Non-Preferred Generic	1	3	000100	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.22	7.00	14.00	21.00																												.22	7.00		17.50				.22	7.00		21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	5	1	Preferred Generic	3	4	001000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	0.00	0.00	0.00	0.00																												0.00	0.00		0.00				0.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5953	002	0		29	10	S5953_002_0	5	5	Specialty Tier	1	4	010010	1	1	111		01		110	1	31	60	90				1				31		90	31		31						33	33	33																												33		33					33		33			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	5	4	Non-Preferred Brand	1	4	110000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	3.06	95.00	190.00	285.00																												3.06	95.00		237.50				3.06	95.00		285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	5	3	Preferred Brand	1	4	000001	1	2	111		01		110	1	31	60	90				1				31		90	31		31	0.96	30.00	60.00	90.00																												.96	30.00		75.00				.96	30.00		90.00				30.00				.96	30.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01		110	1	31	60	90				1				31		90	31		31	0.22	7.00	14.00	21.00																												.22	7.00		17.50				.22	7.00		21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	5	2	Non-Preferred Generic	3	4	000100	1	2	111		01		110	1	31	60	90				1				31		90	31		31	.22	7.00	14.00	21.00																												.22	7.00		17.50				.22	7.00		21.00				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5953	002	0		29	10	S5953_002_0	5	1	Preferred Generic	1	4	001000	1	2	111		01		110	1	31	60	90				1				31		90	31		31	0.00	0.00	0.00	0.00																												.00	0.00		0.00				.00	0.00		0.00				0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5960	108	0		29	10	S5960_108_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	108	0		29	10	S5960_108_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	108	0		29	10	S5960_108_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.10	3.00	6.00	9.00					0.36	11.00	22.00	33.00					.10	3.00	6.00	6.00																		11.00				.32	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	108	0		29	10	S5960_108_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	108	0		29	10	S5960_108_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.23	37.00	74.00	111.00					1.40	42.00	84.00	126.00					1.23	37.00	111.00	111.00																		42.00				1.23	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	108	0		29	10	S5960_108_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.86	86.00	172.00	258.00					3.03	91.00	182.00	273.00					2.86	86.00	258.00	258.00																		91.00				2.67	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	109	0		29	10	S5960_109_0	2	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	109	0		29	10	S5960_109_0	2	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.20	6.00	12.00	18.00					.46	14.00	28.00	42.00					.20	6.00	12.00	12.00																		14.00				.41	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	109	0		29	10	S5960_109_0	2	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.23	37.00	74.00	111.00					1.40	42.00	84.00	126.00					1.23	37.00	111.00	111.00																		42.00				1.23	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	109	0		29	10	S5960_109_0	2	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	109	0		29	10	S5960_109_0	2	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	109	0		29	10	S5960_109_0	2	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.93	88.00	176.00	264.00					3.10	93.00	186.00	279.00					2.93	88.00	264.00	264.00																		93.00				2.73	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	110	0		29	10	S5960_110_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	110	0		29	10	S5960_110_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.10	3.00	6.00	9.00					.36	11.00	22.00	33.00					.10	3.00	6.00	6.00																		11.00				.32	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	110	0		29	10	S5960_110_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.86	86.00	172.00	258.00					3.03	91.00	182.00	273.00					2.86	86.00	258.00	258.00																		91.00				2.67	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	110	0		29	10	S5960_110_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.10	33.00	66.00	99.00					1.26	38.00	76.00	114.00					1.10	33.00	99.00	99.00																		38.00				1.11	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	110	0		29	10	S5960_110_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	110	0		29	10	S5960_110_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	111	0		29	10	S5960_111_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.23	37.00	74.00	111.00					1.40	42.00	84.00	126.00					1.23	37.00	111.00	111.00																		42.00				1.23	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	111	0		29	10	S5960_111_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.33	10.00	20.00	30.00					.06	2.00	4.00	4.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	111	0		29	10	S5960_111_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	111	0		29	10	S5960_111_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	111	0		29	10	S5960_111_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.90	87.00	174.00	261.00					3.06	92.00	184.00	276.00					2.90	87.00	261.00	261.00																		92.00				2.70	92.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	111	0		29	10	S5960_111_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	112	0		29	10	S5960_112_0	4	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	112	0		29	10	S5960_112_0	4	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.86	86.00	172.00	258.00					3.03	91.00	182.00	273.00					2.86	86.00	258.00	258.00																		91.00				2.67	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	112	0		29	10	S5960_112_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.26	38.00	76.00	114.00					1.43	43.00	86.00	129.00					1.26	38.00	114.00	114.00																		43.00				1.26	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	112	0		29	10	S5960_112_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	112	0		29	10	S5960_112_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.16	5.00	10.00	15.00					.43	13.00	26.00	39.00					.16	5.00	10.00	10.00																		13.00				.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	112	0		29	10	S5960_112_0	4	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													86.34	25	25	25					86.34	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	114	0		29	10	S5960_114_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	114	0		29	10	S5960_114_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.13	4.00	8.00	12.00					.40	12.00	24.00	36.00					.13	4.00	8.00	8.00																		12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	114	0		29	10	S5960_114_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	114	0		29	10	S5960_114_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.96	89.00	178.00	267.00					3.13	94.00	188.00	282.00					2.96	89.00	267.00	267.00																		94.00				2.76	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	114	0		29	10	S5960_114_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.26	38.00	76.00	114.00					1.43	43.00	86.00	129.00					1.26	38.00	114.00	114.00																		43.00				1.26	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	114	0		29	10	S5960_114_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													76.17	25	25	25					76.17	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	115	0		29	10	S5960_115_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.13	34.00	68.00	102.00					1.30	39.00	78.00	117.00					1.13	34.00	102.00	102.00																		39.00				1.14	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	115	0		29	10	S5960_115_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.10	3.00	6.00	9.00					.36	11.00	22.00	33.00					.10	3.00	6.00	6.00																		11.00				.32	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	115	0		29	10	S5960_115_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	115	0		29	10	S5960_115_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.86	86.00	172.00	258.00					3.03	91.00	182.00	273.00					2.86	86.00	258.00	258.00																		91.00				2.67	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	115	0		29	10	S5960_115_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	115	0		29	10	S5960_115_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	117	0		29	10	S5960_117_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	117	0		29	10	S5960_117_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.76	83.00	166.00	249.00					2.93	88.00	176.00	264.00					2.76	83.00	249.00	249.00																		88.00				2.58	88.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	117	0		29	10	S5960_117_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.00	30.00	60.00	90.00					1.16	35.00	70.00	105.00					1.00	30.00	90.00	90.00																		35.00				1.02	35.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	117	0		29	10	S5960_117_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.33	10.00	20.00	30.00					.06	2.00	4.00	4.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	117	0		29	10	S5960_117_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	117	0		29	10	S5960_117_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	118	0		29	10	S5960_118_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	118	0		29	10	S5960_118_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.10	3.00	6.00	9.00					.36	11.00	22.00	33.00					.10	3.00	6.00	6.00																		11.00				.32	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	118	0		29	10	S5960_118_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.03	31.00	62.00	93.00					1.20	36.00	72.00	108.00					1.03	31.00	93.00	93.00																		36.00				1.05	36.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	118	0		29	10	S5960_118_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.86	86.00	172.00	258.00					3.03	91.00	182.00	273.00					2.86	86.00	258.00	258.00																		91.00				2.67	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	118	0		29	10	S5960_118_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													64.95	25	25	25					64.95	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	118	0		29	10	S5960_118_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	119	0		29	10	S5960_119_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	119	0		29	10	S5960_119_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.16	5.00	10.00	15.00					.43	13.00	26.00	39.00					.16	5.00	10.00	10.00																		13.00				.38	13.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	119	0		29	10	S5960_119_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.13	34.00	68.00	102.00					1.30	39.00	78.00	117.00					1.13	34.00	102.00	102.00																		39.00				1.14	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	119	0		29	10	S5960_119_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.83	85.00	170.00	255.00					3.00	90.00	180.00	270.00					2.83	85.00	255.00	255.00																		90.00				2.64	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	119	0		29	10	S5960_119_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													85.03	25	25	25					85.03	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	119	0		29	10	S5960_119_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	123	0		29	10	S5960_123_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													63.51	25	25	25					63.51	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	123	0		29	10	S5960_123_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	123	0		29	10	S5960_123_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	123	0		29	10	S5960_123_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.10	3.00	6.00	9.00					.36	11.00	22.00	33.00					.10	3.00	6.00	6.00																		11.00				.32	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	123	0		29	10	S5960_123_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.30	39.00	78.00	117.00					1.46	44.00	88.00	132.00					1.30	39.00	117.00	117.00																		44.00				1.29	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	123	0		29	10	S5960_123_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.83	85.00	170.00	255.00					3.00	90.00	180.00	270.00					2.83	85.00	255.00	255.00																		90.00				2.64	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	125	0		29	10	S5960_125_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													57.94	25	25	25					57.94	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	125	0		29	10	S5960_125_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	125	0		29	10	S5960_125_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	125	0		29	10	S5960_125_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.10	3.00	6.00	9.00					.36	11.00	22.00	33.00					.10	3.00	6.00	6.00																		11.00				.32	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	125	0		29	10	S5960_125_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.13	34.00	68.00	102.00					1.30	39.00	78.00	117.00					1.13	34.00	102.00	102.00																		39.00				1.14	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	125	0		29	10	S5960_125_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.90	87.00	174.00	261.00					3.06	92.00	184.00	276.00					2.90	87.00	261.00	261.00																		92.00				2.70	92.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	126	0		29	10	S5960_126_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	126	0		29	10	S5960_126_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.10	3.00	6.00	9.00					.36	11.00	22.00	33.00					.10	3.00	6.00	6.00																		11.00				.32	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	126	0		29	10	S5960_126_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.26	38.00	76.00	114.00					1.43	43.00	86.00	129.00					1.26	38.00	114.00	114.00																		43.00				1.26	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	126	0		29	10	S5960_126_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.90	87.00	174.00	261.00					3.06	92.00	184.00	276.00					2.90	87.00	261.00	261.00																		92.00				2.70	92.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	126	0		29	10	S5960_126_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													74.57	25	25	25					74.57	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	126	0		29	10	S5960_126_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	127	0		29	10	S5960_127_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	127	0		29	10	S5960_127_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.13	4.00	8.00	12.00					.40	12.00	24.00	36.00					.13	4.00	8.00	8.00																		12.00				.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	127	0		29	10	S5960_127_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.20	36.00	72.00	108.00					1.36	41.00	82.00	123.00					1.20	36.00	108.00	108.00																		41.00				1.20	41.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	127	0		29	10	S5960_127_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.93	88.00	176.00	264.00					3.10	93.00	186.00	279.00					2.93	88.00	264.00	264.00																		93.00				2.73	93.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	127	0		29	10	S5960_127_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													73.66	25	25	25					73.66	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	127	0		29	10	S5960_127_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	128	0		29	10	S5960_128_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	128	0		29	10	S5960_128_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.13	4.00	8.00	12.00					0.40	12.00	24.00	36.00					0.13	4.00	8.00	8.00																		12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	128	0		29	10	S5960_128_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.13	34.00	68.00	102.00					1.30	39.00	78.00	117.00					1.13	34.00	102.00	102.00																		39.00				1.14	39.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	128	0		29	10	S5960_128_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.90	87.00	174.00	261.00					3.06	92.00	184.00	276.00					2.90	87.00	261.00	261.00																		92.00				2.70	92.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	128	0		29	10	S5960_128_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													83.23	25	25	25					83.23	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	128	0		29	10	S5960_128_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	129	0		29	10	S5960_129_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	129	0		29	10	S5960_129_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.13	4.00	8.00	12.00					0.40	12.00	24.00	36.00					0.13	4.00	8.00	8.00																		12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	129	0		29	10	S5960_129_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	129	0		29	10	S5960_129_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.86	86.00	172.00	258.00					3.03	91.00	182.00	273.00					2.86	86.00	258.00	258.00																		91.00				2.67	91.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	129	0		29	10	S5960_129_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													88.14	25	25	25					88.14	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	129	0		29	10	S5960_129_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.10	33.00	66.00	99.00					1.26	38.00	76.00	114.00					1.10	33.00	99.00	99.00																		38.00				1.11	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	130	0		29	10	S5960_130_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	130	0		29	10	S5960_130_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.16	35.00	70.00	105.00					1.33	40.00	80.00	120.00					1.16	35.00	105.00	105.00																		40.00				1.17	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	130	0		29	10	S5960_130_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.90	87.00	174.00	261.00					3.06	92.00	184.00	276.00					2.90	87.00	261.00	261.00																		92.00				2.70	92.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	130	0		29	10	S5960_130_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	130	0		29	10	S5960_130_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.10	3.00	6.00	9.00					0.36	11.00	22.00	33.00					0.10	3.00	6.00	6.00																		11.00				0.32	11.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	130	0		29	10	S5960_130_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													77.87	25	25	25					77.87	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	131	0		29	10	S5960_131_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	131	0		29	10	S5960_131_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	131	0		29	10	S5960_131_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.53	76.00	152.00	228.00					2.70	81.00	162.00	243.00					2.53	76.00	228.00	228.00																		81.00				2.38	81.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	131	0		29	10	S5960_131_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.80	24.00	48.00	72.00					0.96	29.00	58.00	87.00					0.80	24.00	72.00	72.00																		29.00				0.85	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	131	0		29	10	S5960_131_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	131	0		29	10	S5960_131_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.33	10.00	20.00	30.00					.06	2.00	4.00	4.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	132	0		29	10	S5960_132_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.96	89.00	178.00	267.00					3.13	94.00	188.00	282.00					2.96	89.00	267.00	267.00																		94.00				2.76	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	132	0		29	10	S5960_132_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.16	35.00	70.00	105.00					1.33	40.00	80.00	120.00					1.16	35.00	105.00	105.00																		40.00				1.17	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	132	0		29	10	S5960_132_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.13	4.00	8.00	12.00					0.40	12.00	24.00	36.00					0.13	4.00	8.00	8.00																		12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	132	0		29	10	S5960_132_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	132	0		29	10	S5960_132_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	132	0		29	10	S5960_132_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	134	0		29	10	S5960_134_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	134	0		29	10	S5960_134_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.13	4.00	8.00	12.00					0.40	12.00	24.00	36.00					0.13	4.00	8.00	8.00																		12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	134	0		29	10	S5960_134_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	134	0		29	10	S5960_134_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	134	0		29	10	S5960_134_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.96	89.00	178.00	267.00					3.13	94.00	188.00	282.00					2.96	89.00	267.00	267.00																		94.00				2.76	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	134	0		29	10	S5960_134_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.23	37.00	74.00	111.00					1.40	42.00	84.00	126.00					1.23	37.00	111.00	111.00																		42.00				1.23	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	136	0		29	10	S5960_136_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	136	0		29	10	S5960_136_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.13	4.00	8.00	12.00					0.40	12.00	24.00	36.00					0.13	4.00	8.00	8.00																		12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	136	0		29	10	S5960_136_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.23	37.00	74.00	111.00					1.40	42.00	84.00	126.00					1.23	37.00	111.00	111.00																		42.00				1.23	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	136	0		29	10	S5960_136_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	136	0		29	10	S5960_136_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													81.71	25	25	25					81.71	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	136	0		29	10	S5960_136_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	137	0		29	10	S5960_137_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	137	0		29	10	S5960_137_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.16	35.00	70.00	105.00					1.33	40.00	80.00	120.00					1.16	35.00	105.00	105.00																		40.00				1.17	40.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	137	0		29	10	S5960_137_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.83	85.00	170.00	255.00					3.00	90.00	180.00	270.00					2.83	85.00	255.00	255.00																		90.00				2.64	90.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	137	0		29	10	S5960_137_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													78.42	25	25	25					78.42	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	137	0		29	10	S5960_137_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.13	4.00	8.00	12.00					0.40	12.00	24.00	36.00					0.13	4.00	8.00	8.00																		12.00				0.35	12.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	137	0		29	10	S5960_137_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	139	0		29	10	S5960_139_0	3	5	Injectable Drugs	1	3	010010	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.16	95.00	190.00	285.00					3.16	95.00	190.00	285.00					3.16	95.00	285.00	285.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	139	0		29	10	S5960_139_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	139	0		29	10	S5960_139_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	139	0		29	10	S5960_139_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	139	0		29	10	S5960_139_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.96	89.00	178.00	267.00					3.13	94.00	188.00	282.00					2.96	89.00	267.00	267.00																		94.00				2.76	94.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	139	0		29	10	S5960_139_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.26	38.00	76.00	114.00					1.43	43.00	86.00	129.00					1.26	38.00	114.00	114.00																		43.00				1.26	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	140	0		29	10	S5960_140_0	3	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34														25								25							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	140	0		29	10	S5960_140_0	3	5	Injectable Drugs	1	3	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													65.34	25	25	25					65.34	25	25	25					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	140	0		29	10	S5960_140_0	3	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									2.63	79.00	158.00	237.00					2.80	84.00	168.00	252.00					2.63	79.00	237.00	237.00																		84.00				2.47	84.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	140	0		29	10	S5960_140_0	3	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.93	28.00	56.00	84.00					1.10	33.00	66.00	99.00					0.93	28.00	84.00	84.00																		33.00				0.97	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	140	0		29	10	S5960_140_0	3	2	Non-Preferred Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									.06	2.00	4.00	6.00					.33	10.00	20.00	30.00					.06	2.00	4.00	4.00																		10.00				.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	140	0		29	10	S5960_140_0	3	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	147	0		29	10	S5960_147_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	147	0		29	10	S5960_147_0	4	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													67.07	33	33	33					67.07	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	147	0		29	10	S5960_147_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	147	0		29	10	S5960_147_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	147	0		29	10	S5960_147_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	147	0		29	10	S5960_147_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5960	147	0		29	10	S5960_147_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	157	0		29	10	S5960_157_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.03	1.00	2.00	3.00					0.30	9.00	18.00	27.00					0.03	1.00	2.00	2.00																		9.00				.26	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	157	0		29	10	S5960_157_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.23	7.00	14.00	21.00					0.50	15.00	30.00	45.00					0.23	7.00	14.00	14.00																		15.00				0.44	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	157	0		29	10	S5960_157_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									1.33	40.00	80.00	120.00					1.50	45.00	90.00	135.00					1.33	40.00	120.00	120.00																		45.00				1.32	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	157	0		29	10	S5960_157_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									0.16	5.00	10.00	15.00					0.33	10.00	20.00	30.00					0.16	5.00	10.00	10.00																		10.00				0.29	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
S5960	157	0		29	10	S5960_157_0	4	5	Injectable Drugs	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34													66.54	33	33	33					66.54	33	33	33					33	33	33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	157	0		29	10	S5960_157_0	4	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34														33								33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5960	157	0		29	10	S5960_157_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34									3.00	90.00	180.00	270.00					3.16	95.00	190.00	285.00					3.00	90.00	270.00	270.00																		95.00				2.79	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S5966	001	0		29	10	S5966_001_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	.13	4.00	8.00	12.00																					.13	4.00	8.00	12.00																		4.00				.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S5966	001	0		29	10	S5966_001_0	4	4	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					739.76	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S5966	001	0		29	10	S5966_001_0	4	3	Preferred Brand	1	2	000001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					52.13	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S5966	001	0		29	10	S5966_001_0	4	2	Non-Preferred Generic	1	2	000100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					8.88	25	25	25																					25	25	25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S5967	138	0		29	10	S5967_138_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	138	0		29	10	S5967_138_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.93	29.00	58.00	87.00												.32	10.00	20.00	20.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	138	0		29	10	S5967_138_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	138	0		29	10	S5967_138_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	138	0		29	10	S5967_138_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	139	0		29	10	S5967_139_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	139	0		29	10	S5967_139_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.93	29.00	58.00	87.00												.48	15.00	30.00	30.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	139	0		29	10	S5967_139_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	139	0		29	10	S5967_139_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	139	0		29	10	S5967_139_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	140	0		29	10	S5967_140_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	140	0		29	10	S5967_140_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	140	0		29	10	S5967_140_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	140	0		29	10	S5967_140_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.93	29.00	58.00	87.00												.48	15.00	30.00	30.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	140	0		29	10	S5967_140_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	141	0		29	10	S5967_141_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	141	0		29	10	S5967_141_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	141	0		29	10	S5967_141_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.51	16.00	32.00	48.00					.93	29.00	58.00	87.00												.51	16.00	32.00	32.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	141	0		29	10	S5967_141_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	141	0		29	10	S5967_141_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.51	16.00	32.00	48.00					.93	29.00	58.00	87.00												.51	16.00	32.00	32.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	143	0		29	10	S5967_143_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	143	0		29	10	S5967_143_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	143	0		29	10	S5967_143_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.38	12.00	24.00	36.00					.93	29.00	58.00	87.00												.38	12.00	24.00	24.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	143	0		29	10	S5967_143_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	143	0		29	10	S5967_143_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	144	0		29	10	S5967_144_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	144	0		29	10	S5967_144_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	144	0		29	10	S5967_144_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	144	0		29	10	S5967_144_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.51	16.00	32.00	48.00					.93	29.00	58.00	87.00												.51	16.00	32.00	32.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	144	0		29	10	S5967_144_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	145	0		29	10	S5967_145_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	145	0		29	10	S5967_145_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.45	14.00	28.00	42.00					.93	29.00	58.00	87.00												.45	14.00	28.00	28.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	145	0		29	10	S5967_145_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	145	0		29	10	S5967_145_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	145	0		29	10	S5967_145_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	146	0		29	10	S5967_146_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	146	0		29	10	S5967_146_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	146	0		29	10	S5967_146_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	146	0		29	10	S5967_146_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.25	39.00	78.00	117.00					1.45	45.00	90.00	135.00												1.25	39.00	78.00	78.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	146	0		29	10	S5967_146_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.93	29.00	58.00	87.00												.48	15.00	30.00	30.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	147	0		29	10	S5967_147_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.35	11.00	22.00	33.00					.93	29.00	58.00	87.00												.35	11.00	22.00	22.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	147	0		29	10	S5967_147_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	147	0		29	10	S5967_147_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	147	0		29	10	S5967_147_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	147	0		29	10	S5967_147_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	148	0		29	10	S5967_148_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	148	0		29	10	S5967_148_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.45	14.00	28.00	42.00					.93	29.00	58.00	87.00												.45	14.00	28.00	28.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	148	0		29	10	S5967_148_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	148	0		29	10	S5967_148_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	148	0		29	10	S5967_148_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	149	0		29	10	S5967_149_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	149	0		29	10	S5967_149_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.25	39.00	78.00	117.00					1.45	45.00	90.00	135.00												1.25	39.00	78.00	78.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	149	0		29	10	S5967_149_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	149	0		29	10	S5967_149_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.35	11.00	22.00	33.00					.93	29.00	58.00	87.00												.35	11.00	22.00	22.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	149	0		29	10	S5967_149_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	150	0		29	10	S5967_150_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	150	0		29	10	S5967_150_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.51	16.00	32.00	48.00					.93	29.00	58.00	87.00												.51	16.00	32.00	32.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	150	0		29	10	S5967_150_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.25	39.00	78.00	117.00					1.45	45.00	90.00	135.00												1.25	39.00	78.00	78.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	150	0		29	10	S5967_150_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	150	0		29	10	S5967_150_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	151	0		29	10	S5967_151_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	151	0		29	10	S5967_151_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.64	20.00	40.00	60.00					.93	29.00	58.00	87.00												.64	20.00	40.00	40.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	151	0		29	10	S5967_151_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.25	39.00	78.00	117.00					1.45	45.00	90.00	135.00												1.25	39.00	78.00	78.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	151	0		29	10	S5967_151_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	151	0		29	10	S5967_151_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	152	0		29	10	S5967_152_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	152	0		29	10	S5967_152_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.35	11.00	22.00	33.00					.93	29.00	58.00	87.00												.35	11.00	22.00	22.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	152	0		29	10	S5967_152_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	152	0		29	10	S5967_152_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	152	0		29	10	S5967_152_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	154	0		29	10	S5967_154_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	154	0		29	10	S5967_154_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	154	0		29	10	S5967_154_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.54	17.00	34.00	51.00					.93	29.00	58.00	87.00												.54	17.00	34.00	34.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	154	0		29	10	S5967_154_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	154	0		29	10	S5967_154_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	155	0		29	10	S5967_155_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	155	0		29	10	S5967_155_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.41	13.00	26.00	39.00					.93	29.00	58.00	87.00												.41	13.00	26.00	26.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	155	0		29	10	S5967_155_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.25	39.00	78.00	117.00					1.45	45.00	90.00	135.00												1.25	39.00	78.00	78.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	155	0		29	10	S5967_155_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.87	89.00	178.00	267.00					3.06	95.00	190.00	285.00												2.87	89.00	178.00	178.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	155	0		29	10	S5967_155_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	156	0		29	10	S5967_156_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	156	0		29	10	S5967_156_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.25	39.00	78.00	117.00					1.45	45.00	90.00	135.00												1.25	39.00	78.00	78.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	156	0		29	10	S5967_156_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.41	13.00	26.00	39.00					.93	29.00	58.00	87.00												.41	13.00	26.00	26.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	156	0		29	10	S5967_156_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	156	0		29	10	S5967_156_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	157	0		29	10	S5967_157_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	157	0		29	10	S5967_157_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.38	12.00	24.00	36.00					.93	29.00	58.00	87.00												.38	12.00	24.00	24.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	157	0		29	10	S5967_157_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	157	0		29	10	S5967_157_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	157	0		29	10	S5967_157_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	158	0		29	10	S5967_158_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	158	0		29	10	S5967_158_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	158	0		29	10	S5967_158_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.32	10.00	20.00	30.00					.93	29.00	58.00	87.00												.32	10.00	20.00	20.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	158	0		29	10	S5967_158_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	158	0		29	10	S5967_158_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	159	0		29	10	S5967_159_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	159	0		29	10	S5967_159_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	159	0		29	10	S5967_159_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	159	0		29	10	S5967_159_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	159	0		29	10	S5967_159_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.93	29.00	58.00	87.00												.48	15.00	30.00	30.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	160	0		29	10	S5967_160_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.38	12.00	24.00	36.00					.93	29.00	58.00	87.00												.38	12.00	24.00	24.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	160	0		29	10	S5967_160_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.25	39.00	78.00	117.00					1.45	45.00	90.00	135.00												1.25	39.00	78.00	78.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	160	0		29	10	S5967_160_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.87	89.00	178.00	267.00					3.06	95.00	190.00	285.00												2.87	89.00	178.00	178.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	160	0		29	10	S5967_160_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	160	0		29	10	S5967_160_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	161	0		29	10	S5967_161_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.35	11.00	22.00	33.00					.93	29.00	58.00	87.00												.35	11.00	22.00	22.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	161	0		29	10	S5967_161_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	161	0		29	10	S5967_161_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	161	0		29	10	S5967_161_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	161	0		29	10	S5967_161_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	162	0		29	10	S5967_162_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	162	0		29	10	S5967_162_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	162	0		29	10	S5967_162_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	162	0		29	10	S5967_162_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.38	12.00	24.00	36.00					.93	29.00	58.00	87.00												.38	12.00	24.00	24.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	162	0		29	10	S5967_162_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	163	0		29	10	S5967_163_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	163	0		29	10	S5967_163_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	163	0		29	10	S5967_163_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	163	0		29	10	S5967_163_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.61	19.00	38.00	57.00					.93	29.00	58.00	87.00												.61	19.00	38.00	38.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	163	0		29	10	S5967_163_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	164	0		29	10	S5967_164_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.51	16.00	32.00	48.00					.93	29.00	58.00	87.00												.51	16.00	32.00	32.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	164	0		29	10	S5967_164_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	164	0		29	10	S5967_164_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	164	0		29	10	S5967_164_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	164	0		29	10	S5967_164_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	165	0		29	10	S5967_165_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.74	23.00	46.00	69.00					.93	29.00	58.00	87.00												.74	23.00	46.00	46.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	165	0		29	10	S5967_165_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	165	0		29	10	S5967_165_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	165	0		29	10	S5967_165_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	165	0		29	10	S5967_165_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	166	0		29	10	S5967_166_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.45	14.00	28.00	42.00					.93	29.00	58.00	87.00												.45	14.00	28.00	28.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	166	0		29	10	S5967_166_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	166	0		29	10	S5967_166_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	166	0		29	10	S5967_166_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	166	0		29	10	S5967_166_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	167	0		29	10	S5967_167_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.38	12.00	24.00	36.00					.93	29.00	58.00	87.00												.38	12.00	24.00	24.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	167	0		29	10	S5967_167_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	167	0		29	10	S5967_167_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	167	0		29	10	S5967_167_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	167	0		29	10	S5967_167_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	168	0		29	10	S5967_168_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	168	0		29	10	S5967_168_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.35	11.00	22.00	33.00					.93	29.00	58.00	87.00												.35	11.00	22.00	22.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	168	0		29	10	S5967_168_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.25	39.00	78.00	117.00					1.45	45.00	90.00	135.00												1.25	39.00	78.00	78.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	168	0		29	10	S5967_168_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	168	0		29	10	S5967_168_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	169	0		29	10	S5967_169_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	169	0		29	10	S5967_169_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.48	15.00	30.00	45.00					.93	29.00	58.00	87.00												.48	15.00	30.00	30.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	169	0		29	10	S5967_169_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	169	0		29	10	S5967_169_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	169	0		29	10	S5967_169_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	170	0		29	10	S5967_170_0	4	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.67	21.00	42.00	63.00					.93	29.00	58.00	87.00												0.67	21.00	42.00	42.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	170	0		29	10	S5967_170_0	4	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	170	0		29	10	S5967_170_0	4	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	170	0		29	10	S5967_170_0	4	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	170	0		29	10	S5967_170_0	4	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	171	0		29	10	S5967_171_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					0.32	10.00	20.00	30.00												0.00	0.00	0.00	0.00				.32	10.00	20.00	30.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	171	0		29	10	S5967_171_0	5	2	Non-Preferred Generic	1	3	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									.80	25.00	50.00	75.00					1.06	33.00	66.00	99.00												.80	25.00	50.00	50.00				1.06	33.00	66.00	99.00				33.00				1.06	33.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	171	0		29	10	S5967_171_0	5	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00												1.29	40.00	80.00	80.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	171	0		29	10	S5967_171_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00												2.90	90.00	180.00	180.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	171	0		29	10	S5967_171_0	5	5	Specialty Tier	1	3	010010	1	1		010	01		010	1				31							31			31		31													750.08	33							750.08	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	173	0		29	10	S5967_173_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.77	55.00	110.00	165.00					3.06	95.00	190.00	285.00												1.77	55.00	110.00	110.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	173	0		29	10	S5967_173_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	173	0		29	10	S5967_173_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	173	0		29	10	S5967_173_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	173	0		29	10	S5967_173_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	174	0		29	10	S5967_174_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	174	0		29	10	S5967_174_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	174	0		29	10	S5967_174_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.35	73.00	146.00	219.00					3.06	95.00	190.00	285.00												2.35	73.00	146.00	146.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	174	0		29	10	S5967_174_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	174	0		29	10	S5967_174_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	175	0		29	10	S5967_175_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	175	0		29	10	S5967_175_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	175	0		29	10	S5967_175_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.35	73.00	146.00	219.00					3.06	95.00	190.00	285.00												2.35	73.00	146.00	146.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	175	0		29	10	S5967_175_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	175	0		29	10	S5967_175_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	176	0		29	10	S5967_176_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	176	0		29	10	S5967_176_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	176	0		29	10	S5967_176_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.41	75.00	150.00	225.00					3.06	95.00	190.00	285.00												2.41	75.00	150.00	150.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	176	0		29	10	S5967_176_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	176	0		29	10	S5967_176_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	177	0		29	10	S5967_177_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	177	0		29	10	S5967_177_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	177	0		29	10	S5967_177_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.41	75.00	150.00	225.00					3.06	95.00	190.00	285.00												2.41	75.00	150.00	150.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	177	0		29	10	S5967_177_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	177	0		29	10	S5967_177_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	178	0		29	10	S5967_178_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	178	0		29	10	S5967_178_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	178	0		29	10	S5967_178_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.03	63.00	126.00	189.00					3.06	95.00	190.00	285.00												2.03	63.00	126.00	126.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	178	0		29	10	S5967_178_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	178	0		29	10	S5967_178_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	179	0		29	10	S5967_179_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	179	0		29	10	S5967_179_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	179	0		29	10	S5967_179_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	179	0		29	10	S5967_179_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	179	0		29	10	S5967_179_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.41	75.00	150.00	225.00					3.06	95.00	190.00	285.00												2.41	75.00	150.00	150.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	180	0		29	10	S5967_180_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	180	0		29	10	S5967_180_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.19	68.00	136.00	204.00					3.06	95.00	190.00	285.00												2.19	68.00	136.00	136.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	180	0		29	10	S5967_180_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	180	0		29	10	S5967_180_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	180	0		29	10	S5967_180_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	181	0		29	10	S5967_181_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.25	70.00	140.00	210.00					3.06	95.00	190.00	285.00												2.25	70.00	140.00	140.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	181	0		29	10	S5967_181_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	181	0		29	10	S5967_181_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	181	0		29	10	S5967_181_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	181	0		29	10	S5967_181_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	182	0		29	10	S5967_182_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	182	0		29	10	S5967_182_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	182	0		29	10	S5967_182_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	182	0		29	10	S5967_182_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					3.06	95.00	190.00	285.00												1.93	60.00	120.00	120.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	182	0		29	10	S5967_182_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	183	0		29	10	S5967_183_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	183	0		29	10	S5967_183_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	183	0		29	10	S5967_183_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	183	0		29	10	S5967_183_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.19	68.00	136.00	204.00					3.06	95.00	190.00	285.00												2.19	68.00	136.00	136.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	183	0		29	10	S5967_183_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	184	0		29	10	S5967_184_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	184	0		29	10	S5967_184_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	184	0		29	10	S5967_184_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	184	0		29	10	S5967_184_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	184	0		29	10	S5967_184_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.87	58.00	116.00	174.00					3.06	95.00	190.00	285.00												1.87	58.00	116.00	116.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	185	0		29	10	S5967_185_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.35	73.00	146.00	219.00					3.06	95.00	190.00	285.00												2.35	73.00	146.00	146.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	185	0		29	10	S5967_185_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	185	0		29	10	S5967_185_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	185	0		29	10	S5967_185_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	185	0		29	10	S5967_185_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	186	0		29	10	S5967_186_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	186	0		29	10	S5967_186_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.67	83.00	166.00	249.00					3.06	95.00	190.00	285.00												2.67	83.00	166.00	166.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	186	0		29	10	S5967_186_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	186	0		29	10	S5967_186_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	186	0		29	10	S5967_186_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	187	0		29	10	S5967_187_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	187	0		29	10	S5967_187_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	187	0		29	10	S5967_187_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	187	0		29	10	S5967_187_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					3.06	95.00	190.00	285.00												1.93	60.00	120.00	120.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	187	0		29	10	S5967_187_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	188	0		29	10	S5967_188_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	188	0		29	10	S5967_188_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	188	0		29	10	S5967_188_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	188	0		29	10	S5967_188_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	188	0		29	10	S5967_188_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.51	78.00	156.00	234.00					3.06	95.00	190.00	285.00												2.51	78.00	156.00	156.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	189	0		29	10	S5967_189_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	189	0		29	10	S5967_189_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	189	0		29	10	S5967_189_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	189	0		29	10	S5967_189_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.09	65.00	130.00	195.00					3.06	95.00	190.00	285.00												2.09	65.00	130.00	130.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	189	0		29	10	S5967_189_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	190	0		29	10	S5967_190_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	190	0		29	10	S5967_190_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	190	0		29	10	S5967_190_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	190	0		29	10	S5967_190_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.09	65.00	130.00	195.00					3.06	95.00	190.00	285.00												2.09	65.00	130.00	130.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	190	0		29	10	S5967_190_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	191	0		29	10	S5967_191_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	191	0		29	10	S5967_191_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	191	0		29	10	S5967_191_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	191	0		29	10	S5967_191_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					3.06	95.00	190.00	285.00												1.93	60.00	120.00	120.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	191	0		29	10	S5967_191_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	192	0		29	10	S5967_192_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	192	0		29	10	S5967_192_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	192	0		29	10	S5967_192_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	192	0		29	10	S5967_192_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.77	55.00	110.00	165.00					3.06	95.00	190.00	285.00												1.77	55.00	110.00	110.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	192	0		29	10	S5967_192_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	193	0		29	10	S5967_193_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	193	0		29	10	S5967_193_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	193	0		29	10	S5967_193_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	193	0		29	10	S5967_193_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.35	73.00	146.00	219.00					3.06	95.00	190.00	285.00												2.35	73.00	146.00	146.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	193	0		29	10	S5967_193_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	194	0		29	10	S5967_194_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	194	0		29	10	S5967_194_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	194	0		29	10	S5967_194_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					3.06	95.00	190.00	285.00												1.93	60.00	120.00	120.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	194	0		29	10	S5967_194_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	194	0		29	10	S5967_194_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	195	0		29	10	S5967_195_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					3.06	95.00	190.00	285.00												1.93	60.00	120.00	120.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	195	0		29	10	S5967_195_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	195	0		29	10	S5967_195_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	195	0		29	10	S5967_195_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	195	0		29	10	S5967_195_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	196	0		29	10	S5967_196_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	196	0		29	10	S5967_196_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	196	0		29	10	S5967_196_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					3.06	95.00	190.00	285.00												1.93	60.00	120.00	120.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	196	0		29	10	S5967_196_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	196	0		29	10	S5967_196_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	197	0		29	10	S5967_197_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	197	0		29	10	S5967_197_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	197	0		29	10	S5967_197_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	197	0		29	10	S5967_197_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.67	83.00	166.00	249.00					3.06	95.00	190.00	285.00												2.67	83.00	166.00	166.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	197	0		29	10	S5967_197_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	198	0		29	10	S5967_198_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	198	0		29	10	S5967_198_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	198	0		29	10	S5967_198_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	198	0		29	10	S5967_198_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.41	75.00	150.00	225.00					3.06	95.00	190.00	285.00												2.41	75.00	150.00	150.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	198	0		29	10	S5967_198_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	199	0		29	10	S5967_199_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.83	88.00	176.00	264.00					3.06	95.00	190.00	285.00												2.83	88.00	176.00	176.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	199	0		29	10	S5967_199_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	199	0		29	10	S5967_199_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	199	0		29	10	S5967_199_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	199	0		29	10	S5967_199_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	200	0		29	10	S5967_200_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	200	0		29	10	S5967_200_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	200	0		29	10	S5967_200_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	200	0		29	10	S5967_200_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.19	68.00	136.00	204.00					3.06	95.00	190.00	285.00												2.19	68.00	136.00	136.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	200	0		29	10	S5967_200_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	201	0		29	10	S5967_201_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	201	0		29	10	S5967_201_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.93	60.00	120.00	180.00					3.06	95.00	190.00	285.00												1.93	60.00	120.00	120.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	201	0		29	10	S5967_201_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	201	0		29	10	S5967_201_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	201	0		29	10	S5967_201_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	202	0		29	10	S5967_202_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	202	0		29	10	S5967_202_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.87	58.00	116.00	174.00					3.06	95.00	190.00	285.00												1.87	58.00	116.00	116.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	202	0		29	10	S5967_202_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	202	0		29	10	S5967_202_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	202	0		29	10	S5967_202_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	70.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	203	0		29	10	S5967_203_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	203	0		29	10	S5967_203_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.35	73.00	146.00	219.00					3.06	95.00	190.00	285.00												2.35	73.00	146.00	146.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	203	0		29	10	S5967_203_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	203	0		29	10	S5967_203_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	203	0		29	10	S5967_203_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	204	0		29	10	S5967_204_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	204	0		29	10	S5967_204_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	204	0		29	10	S5967_204_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	204	0		29	10	S5967_204_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.83	88.00	176.00	264.00					3.06	95.00	190.00	285.00												2.83	88.00	176.00	176.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	204	0		29	10	S5967_204_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	205	0		29	10	S5967_205_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.25	8.00	16.00	24.00												0.00	0.00	0.00	0.00				.25	8.00	16.00	24.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	205	0		29	10	S5967_205_0	4	2	Non-Preferred Generic	1	4	000100	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									0.00	0.00	0.00	0.00					.93	29.00	58.00	87.00												0.00	0.00	0.00	0.00				.93	29.00	58.00	87.00				29.00				.93	29.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	205	0		29	10	S5967_205_0	4	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									1.22	38.00	76.00	114.00					1.45	45.00	90.00	135.00												1.22	38.00	76.00	76.00				1.45	45.00	90.00	135.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	205	0		29	10	S5967_205_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31													734.71	33							734.71	33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	205	0		29	10	S5967_205_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				31	62	93	1				31	62	93	31		31									2.83	88.00	176.00	264.00					3.06	95.00	190.00	285.00												2.83	88.00	176.00	176.00				3.06	95.00	190.00	285.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	004	0		29	10	S5983_004_0	2	1	Preferred Generic	1	2	001010	1	2	110		01		100	1	31		90				2						90	31		31	.06	2.00		6.00																															4.00							6.00				2.00				.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	004	0		29	10	S5983_004_0	2	2	Non-Preferred Generic	1	2	000110	1	2	110		01		100	1	31		90				2						90	31		31	.19	6.00		18.00																															12.00							18.00				6.00				.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	004	0		29	10	S5983_004_0	2	3	Preferred Brand	1	2	010001	1	1	110		01		100	1	31		90				2						90	31		31					47.41	25		25																														25							25			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	004	0		29	10	S5983_004_0	2	4	Non-Preferred Brand	1	2	110000	1	1	110		01		100	1	31		90				2						90	31		31					71.45	50		50																														50							50			50				50	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	004	0		29	10	S5983_004_0	2	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	31										31			31		31						25																														25							25					25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	2	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	2						90	31		31									.06	2.00		5.00					.25	8.00		20.00															0.00							16.00				8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	2	2	Non-Preferred Generic	1	4	000110	1	2		110	01		100	1				31		90	2						90	31		31									.29	9.00		23.00					.51	16.00		40.00															18.00							32.00				16.00				.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	2						90	31		31									1.29	40.00		120.00					1.45	45.00		135.00															100.00							113.00				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				31		90	2						90	31		31									2.90	90.00		270.00					3.06	95.00		285.00															225.00							238.00				95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31														33								33														33							33					33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	5	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	5	5	Specialty Tier	1	2	010010	1	1	010		01			1	30													30		31					25.00	25																																										25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	5	4	Non-Preferred Brand	1	2	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.80	84.00	168.00	252.00																					2.80	84.00	168.00	252.00																		84.00				2.70	84.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	5	3	Preferred Brand	1	2	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.40	42.00	84.00	126.00																					1.40	42.00	84.00	126.00																		42.00				1.35	42.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	5	2	Non-Preferred Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.50	15.00	30.00	45.00																					0.25	7.50	15.00	22.50																		15.00				0.48	15.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5993	003	0		29	10	S5993_003_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31					33.00	33																																										33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.53	76.00	152.00	228.00																					2.53	76.00	152.00	228.00																		76.00				2.45	76.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	1.26	38.00	76.00	114.00																					1.26	38.00	76.00	114.00																		38.00				1.22	38.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	6	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.53	16.00	32.00	48.00																					0.26	8.00	16.00	24.00																		16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	6	2	Non-Preferred Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.53	16.00	32.00	48.00																					0.26	8.00	16.00	24.00																		16.00				0.51	16.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5993	003	0		29	10	S5993_003_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00	0.00																					0.00	0.00	0.00	0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		111	1				31	60	90	1				31	60	90	31		31									0.00	0.00	0.00	0.00					.22	7.00	14.00	21.00												0.00	0.00	0.00	0.00				.22	7.00	14.00	17.50				7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S6506	001	0		29	10	S6506_001_0	4	2	Non-Preferred Generic	1	2	000100	1	2		111	01		111	1				31	60	90	1				31	60	90	31		31									.12	4.00	8.00	12.00					.32	10.00	20.00	30.00												.12	4.00	8.00	10.00				.32	10.00	20.00	25.00				10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S6506	001	0		29	10	S6506_001_0	4	3	Preferred Brand	1	2	000001	1	2		111	01		111	1				31	60	90	1				31	60	90	31		31									1.12	35.00	70.00	105.00					1.45	45.00	90.00	135.00												1.12	35.00	70.00	87.50				1.45	45.00	90.00	112.50				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S6506	001	0		29	10	S6506_001_0	4	4	Non-Preferred Brand	1	2	110000	1	1		111	01		111	1				31	60	90	1				31	60	90	31		31													55.96	46	46	46					55.96	46	46	46												46	46	46					46	46	46			46				46	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S6506	002	0		29	10	S6506_002_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.09	3.00	6.00	9.00																					.09	3.00	6.00	7.50																		3.00				.09	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S6506	002	0		29	10	S6506_002_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	.45	14.00	28.00	42.00																					.45	14.00	28.00	35.00																		14.00				.45	14.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S6506	002	0		29	10	S6506_002_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	1.45	45.00	90.00	135.00																					1.45	45.00	90.00	112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S6506	002	0		29	10	S6506_002_0	4	4	Non-Preferred Brand	1	4	110000	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31					35.99	46	46	46																					46	46	46																	46				46	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand												
S7230	001	0		29	10	S7230_001_0	1	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	31		90				2			90				31		31	.25	8.00		24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	001	0		29	10	S7230_001_0	1	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	31		90				2			90				31		31	.12	4.00		12.00																								10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	001	0		29	10	S7230_001_0	1	3	Preferred Brand	1	2	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	001	0		29	10	S7230_001_0	1	4	Non-Preferred Brand	1	2	100000	1	2	110		01	100		1	31		90				2			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	001	0		29	10	S7230_001_0	1	5	Specialty Tier	1	2	100000	1	1	110		01	100		1	31		90				2			90				31		31						25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	002	0		29	10	S7230_002_0	1	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	31		90				2			90				31		31	.22	7.00		21.00																								17.50																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	002	0		29	10	S7230_002_0	1	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	31		90				2			90				31		31	.12	4.00		12.00																								10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	002	0		29	10	S7230_002_0	1	3	Preferred Brand	1	2	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.41	44.00		132.00																								110.00																		44.00				1.41	44.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	002	0		29	10	S7230_002_0	1	5	Specialty Tier	1	2	100000	1	1	110		01	100		1	31		90				2			90				31		31						25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	002	0		29	10	S7230_002_0	1	4	Non-Preferred Brand	1	2	100000	1	2	110		01	100		1	31		90				2			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	003	0		29	10	S7230_003_0	1	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	31		90				2			90				31		31	.12	4.00		12.00																								10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	003	0		29	10	S7230_003_0	1	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	31		90				2			90				31		31	.22	7.00		21.00																								17.50																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	003	0		29	10	S7230_003_0	1	4	Non-Preferred Brand	1	2	100000	1	2	110		01	100		1	31		90				2			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	003	0		29	10	S7230_003_0	1	3	Preferred Brand	1	2	000001	1	2	110		01	100		1	31		90				2			90				31		31	1.38	43.00		129.00																								107.50																		43.00				1.38	43.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	003	0		29	10	S7230_003_0	1	5	Specialty Tier	1	2	100000	1	1	110		01	100		1	31		90				2			90				31		31						25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7610	001	0		29	10	S7610_001_0	1	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	31		90				1			90				31		31	.12	4.00		12.00																								10.00																		4.00				.12	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7610	001	0		29	10	S7610_001_0	1	2	Non-Preferred Generic	1	2	000100	1	2	110		01	100		1	31		90				1			90				31		31	.22	7.00		21.00																								17.50																		7.00				.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7610	001	0		29	10	S7610_001_0	1	5	Specialty Tier	1	2	100000	1	1	110		01	100		1	31		90				1			90				31		31						25		25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7610	001	0		29	10	S7610_001_0	1	4	Non-Preferred Brand	1	2	100000	1	2	110		01	100		1	31		90				1			90				31		31	3.06	95.00		285.00																								237.50																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7610	001	0		29	10	S7610_001_0	1	3	Preferred Brand	1	2	000001	1	2	110		01	100		1	31		90				1			90				31		31	1.45	45.00		135.00																								112.50																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	001	0		29	10	S7694_001_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	001	0		29	10	S7694_001_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	001	0		29	10	S7694_001_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					8.20	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	001	0		29	10	S7694_001_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	001	0		29	10	S7694_001_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					75.32	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	002	0		29	10	S7694_002_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					7.13	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	002	0		29	10	S7694_002_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.13	4.00		12.00																					0.13	4.00		12.00																		4.00				0.13	4.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	002	0		29	10	S7694_002_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	002	0		29	10	S7694_002_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					57.94	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	002	0		29	10	S7694_002_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	002	0		29	10	S7694_002_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	003	0		29	10	S7694_003_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	003	0		29	10	S7694_003_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					7.87	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	003	0		29	10	S7694_003_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	003	0		29	10	S7694_003_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					78.95	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	003	0		29	10	S7694_003_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	003	0		29	10	S7694_003_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	004	0		29	10	S7694_004_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	004	0		29	10	S7694_004_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					7.15	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	004	0		29	10	S7694_004_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	004	0		29	10	S7694_004_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	004	0		29	10	S7694_004_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					86.16	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	004	0		29	10	S7694_004_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	005	0		29	10	S7694_005_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	005	0		29	10	S7694_005_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	005	0		29	10	S7694_005_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					93.84	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	005	0		29	10	S7694_005_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	005	0		29	10	S7694_005_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.66	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	005	0		29	10	S7694_005_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.23	7.00		21.00																					0.23	7.00		21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	006	0		29	10	S7694_006_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	006	0		29	10	S7694_006_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	006	0		29	10	S7694_006_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					68.36	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	006	0		29	10	S7694_006_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.89	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	006	0		29	10	S7694_006_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	006	0		29	10	S7694_006_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.30	9.00		27.00																					0.30	9.00		27.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	007	0		29	10	S7694_007_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	007	0		29	10	S7694_007_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.96	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	007	0		29	10	S7694_007_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.23	7.00		21.00																					0.23	7.00		21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	007	0		29	10	S7694_007_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					75.97	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	007	0		29	10	S7694_007_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	007	0		29	10	S7694_007_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	008	0		29	10	S7694_008_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					66.68	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	008	0		29	10	S7694_008_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					5.94	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	008	0		29	10	S7694_008_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	008	0		29	10	S7694_008_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.27	8.00		24.00																					0.27	8.00		24.00																		8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	008	0		29	10	S7694_008_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	008	0		29	10	S7694_008_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	009	0		29	10	S7694_009_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	009	0		29	10	S7694_009_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					7.76	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	009	0		29	10	S7694_009_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.27	8.00		24.00																					0.27	8.00		24.00																		8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	009	0		29	10	S7694_009_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					69.61	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	009	0		29	10	S7694_009_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	009	0		29	10	S7694_009_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	010	0		29	10	S7694_010_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					7.40	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	010	0		29	10	S7694_010_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	010	0		29	10	S7694_010_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					71.92	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	010	0		29	10	S7694_010_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	010	0		29	10	S7694_010_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	010	0		29	10	S7694_010_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.20	6.00		18.00																					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	011	0		29	10	S7694_011_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.54	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	011	0		29	10	S7694_011_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	011	0		29	10	S7694_011_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	011	0		29	10	S7694_011_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	011	0		29	10	S7694_011_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	011	0		29	10	S7694_011_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					63.46	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	012	0		29	10	S7694_012_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.58	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	012	0		29	10	S7694_012_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	012	0		29	10	S7694_012_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					73.32	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	012	0		29	10	S7694_012_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	012	0		29	10	S7694_012_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	012	0		29	10	S7694_012_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.17	5.00		15.00																					0.17	5.00		15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	014	0		29	10	S7694_014_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	014	0		29	10	S7694_014_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	014	0		29	10	S7694_014_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					81.22	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	014	0		29	10	S7694_014_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	014	0		29	10	S7694_014_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.39	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	014	0		29	10	S7694_014_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	015	0		29	10	S7694_015_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	015	0		29	10	S7694_015_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	015	0		29	10	S7694_015_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					85.16	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	015	0		29	10	S7694_015_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	015	0		29	10	S7694_015_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	015	0		29	10	S7694_015_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.63	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	016	0		29	10	S7694_016_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	016	0		29	10	S7694_016_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	016	0		29	10	S7694_016_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	016	0		29	10	S7694_016_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					83.12	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	016	0		29	10	S7694_016_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	016	0		29	10	S7694_016_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.54	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	017	0		29	10	S7694_017_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	017	0		29	10	S7694_017_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	017	0		29	10	S7694_017_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					78.10	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	017	0		29	10	S7694_017_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	017	0		29	10	S7694_017_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.89	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	017	0		29	10	S7694_017_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.30	9.00		27.00																					0.30	9.00		27.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	018	0		29	10	S7694_018_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	018	0		29	10	S7694_018_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	018	0		29	10	S7694_018_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					54.74	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	018	0		29	10	S7694_018_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	018	0		29	10	S7694_018_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.27	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	018	0		29	10	S7694_018_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.10	3.00		9.00																					0.10	3.00		9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	019	0		29	10	S7694_019_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.17	5.00		15.00																					0.17	5.00		15.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	019	0		29	10	S7694_019_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					7.39	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	019	0		29	10	S7694_019_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	019	0		29	10	S7694_019_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					83.38	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	019	0		29	10	S7694_019_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	019	0		29	10	S7694_019_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	020	0		29	10	S7694_020_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	020	0		29	10	S7694_020_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					5.77	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	020	0		29	10	S7694_020_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	020	0		29	10	S7694_020_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					73.42	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	020	0		29	10	S7694_020_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	020	0		29	10	S7694_020_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	021	0		29	10	S7694_021_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	021	0		29	10	S7694_021_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	021	0		29	10	S7694_021_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	021	0		29	10	S7694_021_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.12	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	021	0		29	10	S7694_021_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	021	0		29	10	S7694_021_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					86.51	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	022	0		29	10	S7694_022_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					81.48	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	022	0		29	10	S7694_022_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	022	0		29	10	S7694_022_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	022	0		29	10	S7694_022_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.73	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	022	0		29	10	S7694_022_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	022	0		29	10	S7694_022_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	023	0		29	10	S7694_023_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					7.07	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	023	0		29	10	S7694_023_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	023	0		29	10	S7694_023_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	023	0		29	10	S7694_023_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	023	0		29	10	S7694_023_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	023	0		29	10	S7694_023_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					71.12	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	024	0		29	10	S7694_024_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	024	0		29	10	S7694_024_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.53	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	024	0		29	10	S7694_024_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	024	0		29	10	S7694_024_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					88.08	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	024	0		29	10	S7694_024_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	024	0		29	10	S7694_024_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	025	0		29	10	S7694_025_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	025	0		29	10	S7694_025_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					70.16	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	025	0		29	10	S7694_025_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	025	0		29	10	S7694_025_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.26	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	025	0		29	10	S7694_025_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	025	0		29	10	S7694_025_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	026	0		29	10	S7694_026_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	026	0		29	10	S7694_026_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					72.95	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	026	0		29	10	S7694_026_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	026	0		29	10	S7694_026_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					7.66	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	026	0		29	10	S7694_026_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	026	0		29	10	S7694_026_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	027	0		29	10	S7694_027_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	027	0		29	10	S7694_027_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					66.53	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	027	0		29	10	S7694_027_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	027	0		29	10	S7694_027_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.79	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	027	0		29	10	S7694_027_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	027	0		29	10	S7694_027_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	028	0		29	10	S7694_028_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.23	7.00		21.00																					0.23	7.00		21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	028	0		29	10	S7694_028_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					8.52	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	028	0		29	10	S7694_028_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	028	0		29	10	S7694_028_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					56.70	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	028	0		29	10	S7694_028_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	028	0		29	10	S7694_028_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	029	0		29	10	S7694_029_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.10	3.00		9.00																					0.10	3.00		9.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	029	0		29	10	S7694_029_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					6.07	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	029	0		29	10	S7694_029_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	029	0		29	10	S7694_029_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					56.16	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	029	0		29	10	S7694_029_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	029	0		29	10	S7694_029_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	030	0		29	10	S7694_030_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					7.69	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	030	0		29	10	S7694_030_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.20	6.00		18.00																					0.20	6.00		18.00																		6.00				0.19	6.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	030	0		29	10	S7694_030_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	030	0		29	10	S7694_030_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					63.89	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	030	0		29	10	S7694_030_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	030	0		29	10	S7694_030_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	031	0		29	10	S7694_031_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.30	9.00		27.00																					0.30	9.00		27.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	031	0		29	10	S7694_031_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					8.04	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	031	0		29	10	S7694_031_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	031	0		29	10	S7694_031_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					91.82	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	031	0		29	10	S7694_031_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	031	0		29	10	S7694_031_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	032	0		29	10	S7694_032_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					5.89	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	032	0		29	10	S7694_032_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.23	7.00		21.00																					0.23	7.00		21.00																		7.00				0.23	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	032	0		29	10	S7694_032_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	032	0		29	10	S7694_032_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	032	0		29	10	S7694_032_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	032	0		29	10	S7694_032_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					82.15	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	033	0		29	10	S7694_033_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.27	8.00		24.00																					0.27	8.00		24.00																		8.00				0.26	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	033	0		29	10	S7694_033_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					7.92	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	033	0		29	10	S7694_033_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	033	0		29	10	S7694_033_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					71.08	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	033	0		29	10	S7694_033_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	033	0		29	10	S7694_033_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	034	0		29	10	S7694_034_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.07	2.00		6.00																					0.07	2.00		6.00																		2.00				0.06	2.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	034	0		29	10	S7694_034_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					5.18	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	034	0		29	10	S7694_034_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	034	0		29	10	S7694_034_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					59.38	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	034	0		29	10	S7694_034_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	034	0		29	10	S7694_034_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	070	0		29	10	S7694_070_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	070	0		29	10	S7694_070_0	2	2	Non-Preferred Generic	1	2	000100	1	1	010		01	010		1	30							30						30		31					7.39	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	070	0		29	10	S7694_070_0	2	6	Select Care Drugs	1	2	000010	1	2	110		01	110		1	30		90				1	30		90				30		31	0.33	10.00		30.00																					0.33	10.00		30.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	070	0		29	10	S7694_070_0	2	4	Non-Preferred Brand	1	2	100000	1	1	010		01	010		1	30							30						30		31					80.53	45																							45																			45				45	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	070	0		29	10	S7694_070_0	2	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31					1.00	25																							25																			25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S7694	070	0		29	10	S7694_070_0	2	3	Preferred Brand	1	2	000001	1	2	010		01	010		1	30							30						30		31	1.50	45.00																							1.50	45.00																				45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S8067	001	0		29	10	S8067_001_0	5	4	Specialty Tier	1	3	010010	1	1		010	01	010		1				31				31						31		31													512.00	33							512.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	5	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.29	40.00		120.00					1.45	45.00		135.00					1.29	40.00		120.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	5	2	Non-Preferred Generic	1	3	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.61	19.00		57.00					.82	25.50		76.50					.61	19.00		57.00																		25.50				.82	25.50		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	5	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.16	5.00		15.00					.32	10.00		30.00					.16	5.00		15.00																		10.00				.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31									2.87	89.00		267.00					3.06	95.00		285.00					2.87	89.00		267.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	4	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31									1.23	38.00		114.00					1.45	45.00		135.00					1.23	38.00		114.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	4	2	Non-Preferred Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31									.48	15.00		45.00					.68	21.00		63.00					.48	15.00		45.00																		21.00				.68	21.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	4	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31													559.00	33							559.00	33							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	4	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31									.13	4.00		12.00					.29	9.00		27.00					.13	4.00		12.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9014	002	0		29	10	S9014_002_0	2	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S9014	002	0		29	10	S9014_002_0	2	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S9014	002	0		29	10	S9014_002_0	2	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S9014	002	0		29	10	S9014_002_0	2	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S9014	002	0		29	10	S9014_002_0	2	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
S9014	002	0		29	10	S9014_002_0	2	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
S9014	004	0		29	10	S9014_004_0	2	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S9014	004	0		29	10	S9014_004_0	2	2	Non-Preferred Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S9014	004	0		29	10	S9014_004_0	2	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	1.50	45.00		135.00																								90.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S9014	004	0		29	10	S9014_004_0	2	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					1.00	33																							33																			33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier												
S9014	004	0		29	10	S9014_004_0	2	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.10	3.00		9.00																								6.00																		3.00				0.10	3.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
S9014	004	0		29	10	S9014_004_0	2	2	Non-Preferred Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	0.33	10.00		30.00																								20.00																		10.00				0.32	10.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier										1		
S9579	001	0		29	10	S9579_001_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	001	0		29	10	S9579_001_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	001	0		29	10	S9579_001_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	001	0		29	10	S9579_001_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	001	0		29	10	S9579_001_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					673.56	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	002	0		29	10	S9579_002_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					699.29	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	002	0		29	10	S9579_002_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	002	0		29	10	S9579_002_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	002	0		29	10	S9579_002_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.29	9.00	18.00	27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	002	0		29	10	S9579_002_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	003	0		29	10	S9579_003_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	003	0		29	10	S9579_003_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.29	9.00	18.00	27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	003	0		29	10	S9579_003_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	003	0		29	10	S9579_003_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	003	0		29	10	S9579_003_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					615.37	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	004	0		29	10	S9579_004_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					682.81	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	004	0		29	10	S9579_004_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	004	0		29	10	S9579_004_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	004	0		29	10	S9579_004_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.29	9.00	18.00	27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	004	0		29	10	S9579_004_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	005	0		29	10	S9579_005_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					685.66	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	005	0		29	10	S9579_005_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	005	0		29	10	S9579_005_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	005	0		29	10	S9579_005_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.25	8.00	16.00	24.00																								25.00																		8.00				.12	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	005	0		29	10	S9579_005_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	006	0		29	10	S9579_006_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	006	0		29	10	S9579_006_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					669.59	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	006	0		29	10	S9579_006_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	006	0		29	10	S9579_006_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	006	0		29	10	S9579_006_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	007	0		29	10	S9579_007_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	007	0		29	10	S9579_007_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					674.81	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	007	0		29	10	S9579_007_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	007	0		29	10	S9579_007_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	007	0		29	10	S9579_007_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								25.00																		8.00				.12	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	008	0		29	10	S9579_008_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	008	0		29	10	S9579_008_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.29	9.00	18.00	27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	008	0		29	10	S9579_008_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	008	0		29	10	S9579_008_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					610.71	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	008	0		29	10	S9579_008_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	009	0		29	10	S9579_009_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	009	0		29	10	S9579_009_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					667.89	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	009	0		29	10	S9579_009_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	009	0		29	10	S9579_009_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	009	0		29	10	S9579_009_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	010	0		29	10	S9579_010_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								25.00																		8.00				.12	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	010	0		29	10	S9579_010_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	010	0		29	10	S9579_010_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	010	0		29	10	S9579_010_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					691.34	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	010	0		29	10	S9579_010_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	011	0		29	10	S9579_011_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	011	0		29	10	S9579_011_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	011	0		29	10	S9579_011_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	011	0		29	10	S9579_011_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	011	0		29	10	S9579_011_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					670.01	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	012	0		29	10	S9579_012_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				31	60	90	1			90				31		31									0.00	0.00	0.00	0.00					0.16	5.00	10.00	15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	012	0		29	10	S9579_012_0	4	2	Non-Preferred Generic	1	2	000100	1	2		111	01	100		1				31	60	90	1			90				31		31									.12	4.00	8.00	12.00					.29	9.00	18.00	27.00								25.00																		9.00				0.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	012	0		29	10	S9579_012_0	4	3	Preferred Brand	1	2	000001	1	2		111	01	100		1				31	60	90	1			90				31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	012	0		29	10	S9579_012_0	4	4	Non-Preferred Brand	1	2	100000	1	2		111	01	100		1				31	60	90	1			90				31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	012	0		29	10	S9579_012_0	4	5	Specialty Tier	1	2	010010	1	1		111	01	100		1				31	60	90	1			90				31		31													685.69	25	25	25					691.78	25	25	25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	013	0		29	10	S9579_013_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	013	0		29	10	S9579_013_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					667.90	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	013	0		29	10	S9579_013_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	013	0		29	10	S9579_013_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	013	0		29	10	S9579_013_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	014	0		29	10	S9579_014_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	014	0		29	10	S9579_014_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	014	0		29	10	S9579_014_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	014	0		29	10	S9579_014_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	014	0		29	10	S9579_014_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					666.21	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	015	0		29	10	S9579_015_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	015	0		29	10	S9579_015_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.29	9.00	18.00	27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	015	0		29	10	S9579_015_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	015	0		29	10	S9579_015_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	015	0		29	10	S9579_015_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					705.37	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	016	0		29	10	S9579_016_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	016	0		29	10	S9579_016_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	016	0		29	10	S9579_016_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	016	0		29	10	S9579_016_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	016	0		29	10	S9579_016_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					679.34	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	017	0		29	10	S9579_017_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	017	0		29	10	S9579_017_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	017	0		29	10	S9579_017_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	017	0		29	10	S9579_017_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	017	0		29	10	S9579_017_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					667.76	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	018	0		29	10	S9579_018_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	018	0		29	10	S9579_018_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	018	0		29	10	S9579_018_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	018	0		29	10	S9579_018_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					672.48	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	018	0		29	10	S9579_018_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	019	0		29	10	S9579_019_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	019	0		29	10	S9579_019_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	019	0		29	10	S9579_019_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	019	0		29	10	S9579_019_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	019	0		29	10	S9579_019_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					670.53	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	020	0		29	10	S9579_020_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	020	0		29	10	S9579_020_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	020	0		29	10	S9579_020_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	020	0		29	10	S9579_020_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	020	0		29	10	S9579_020_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					665.31	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	021	0		29	10	S9579_021_0	4	4	Non-Preferred Brand	1	2	100000	1	2		111	01	100		1				31	60	90	1			90				31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	021	0		29	10	S9579_021_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				31	60	90	1			90				31		31									0.00	0.00	0.00	0.00					0.16	5.00	10.00	15.00								0.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	021	0		29	10	S9579_021_0	4	2	Non-Preferred Generic	1	2	000100	1	2		111	01	100		1				31	60	90	1			90				31		31									0.12	4.00	8.00	12.00					0.29	9.00	18.00	27.00								20.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	021	0		29	10	S9579_021_0	4	3	Preferred Brand	1	2	000001	1	2		111	01	100		1				31	60	90	1			90				31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	021	0		29	10	S9579_021_0	4	5	Specialty Tier	1	2	010010	1	1		111	01	100		1				31	60	90	1			90				31		31													671.36	25	25	25					683.30	25	25	25							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	022	0		29	10	S9579_022_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					682.68	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	022	0		29	10	S9579_022_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	022	0		29	10	S9579_022_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	022	0		29	10	S9579_022_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								25.00																		8.00				.12	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	022	0		29	10	S9579_022_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	023	0		29	10	S9579_023_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					677.94	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	023	0		29	10	S9579_023_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	023	0		29	10	S9579_023_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	023	0		29	10	S9579_023_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	023	0		29	10	S9579_023_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	024	0		29	10	S9579_024_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	024	0		29	10	S9579_024_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	024	0		29	10	S9579_024_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					683.04	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	024	0		29	10	S9579_024_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	024	0		29	10	S9579_024_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.29	9.00	18.00	27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					712.17	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	026	0		29	10	S9579_026_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					682.75	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	026	0		29	10	S9579_026_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	026	0		29	10	S9579_026_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	026	0		29	10	S9579_026_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	026	0		29	10	S9579_026_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								25.00																		8.00				.12	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	027	0		29	10	S9579_027_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					665.63	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	027	0		29	10	S9579_027_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	027	0		29	10	S9579_027_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	027	0		29	10	S9579_027_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	027	0		29	10	S9579_027_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	028	0		29	10	S9579_028_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	028	0		29	10	S9579_028_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	028	0		29	10	S9579_028_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.29	9.00	18.00	27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	028	0		29	10	S9579_028_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	028	0		29	10	S9579_028_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					705.32	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	029	0		29	10	S9579_029_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					664.83	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	029	0		29	10	S9579_029_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	029	0		29	10	S9579_029_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	029	0		29	10	S9579_029_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.25	8.00	16.00	24.00																								20.00																		8.00				.25	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	029	0		29	10	S9579_029_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	030	0		29	10	S9579_030_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	030	0		29	10	S9579_030_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	030	0		29	10	S9579_030_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								25.00																		8.00				.12	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	030	0		29	10	S9579_030_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	030	0		29	10	S9579_030_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					670.76	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	031	0		29	10	S9579_031_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	031	0		29	10	S9579_031_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	031	0		29	10	S9579_031_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.25	8.00	16.00	24.00																								25.00																		8.00				.12	8.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	031	0		29	10	S9579_031_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	031	0		29	10	S9579_031_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					693.07	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	032	0		29	10	S9579_032_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	032	0		29	10	S9579_032_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.29	9.00	18.00	27.00																								25.00																		9.00				.29	9.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	032	0		29	10	S9579_032_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	032	0		29	10	S9579_032_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	032	0		29	10	S9579_032_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					630.93	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	033	0		29	10	S9579_033_0	4	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	033	0		29	10	S9579_033_0	4	2	Non-Preferred Generic	1	2	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	.22	7.00	14.00	21.00																								15.00																		7.00				0.22	7.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	033	0		29	10	S9579_033_0	4	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	033	0		29	10	S9579_033_0	4	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	033	0		29	10	S9579_033_0	4	5	Specialty Tier	1	2	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					585.71	25	25	25																							25																	25				25	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	034	0		29	10	S9579_034_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	034	0		29	10	S9579_034_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	034	0		29	10	S9579_034_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	034	0		29	10	S9579_034_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	034	0		29	10	S9579_034_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					966.38	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	035	0		29	10	S9579_035_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	035	0		29	10	S9579_035_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	035	0		29	10	S9579_035_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	035	0		29	10	S9579_035_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	035	0		29	10	S9579_035_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					1007.18	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	036	0		29	10	S9579_036_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	036	0		29	10	S9579_036_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	036	0		29	10	S9579_036_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	036	0		29	10	S9579_036_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	036	0		29	10	S9579_036_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					973.43	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	037	0		29	10	S9579_037_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	037	0		29	10	S9579_037_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	037	0		29	10	S9579_037_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	037	0		29	10	S9579_037_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					980.80	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	037	0		29	10	S9579_037_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	038	0		29	10	S9579_038_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	038	0		29	10	S9579_038_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	038	0		29	10	S9579_038_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	038	0		29	10	S9579_038_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	038	0		29	10	S9579_038_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					989.63	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	039	0		29	10	S9579_039_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	039	0		29	10	S9579_039_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	039	0		29	10	S9579_039_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	039	0		29	10	S9579_039_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	039	0		29	10	S9579_039_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					967.30	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	040	0		29	10	S9579_040_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	040	0		29	10	S9579_040_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	040	0		29	10	S9579_040_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	040	0		29	10	S9579_040_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	040	0		29	10	S9579_040_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					973.09	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	041	0		29	10	S9579_041_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	041	0		29	10	S9579_041_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					973.12	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	041	0		29	10	S9579_041_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	041	0		29	10	S9579_041_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	041	0		29	10	S9579_041_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	042	0		29	10	S9579_042_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	042	0		29	10	S9579_042_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	042	0		29	10	S9579_042_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	042	0		29	10	S9579_042_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	042	0		29	10	S9579_042_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					961.56	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	043	0		29	10	S9579_043_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					994.30	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	043	0		29	10	S9579_043_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	043	0		29	10	S9579_043_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	043	0		29	10	S9579_043_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	043	0		29	10	S9579_043_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	044	0		29	10	S9579_044_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	044	0		29	10	S9579_044_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	044	0		29	10	S9579_044_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	044	0		29	10	S9579_044_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					969.19	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	044	0		29	10	S9579_044_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	045	0		29	10	S9579_045_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				31	60	90	1			90				31		31									0.00	0.00	0.00	0.00					.16	5.00	10.00	15.00								0.00																		5.00				0.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	045	0		29	10	S9579_045_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	100		1				31	60	90	1			90				31		31									0.48	15.00	30.00	45.00					0.64	20.00	40.00	60.00								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	045	0		29	10	S9579_045_0	5	5	Specialty Tier	1	4	010010	1	1		111	01	100		1				31	60	90	1			90				31		31													988.67	33	33	33					997.45	33	33	33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	045	0		29	10	S9579_045_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	100		1				31	60	90	1			90				31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	045	0		29	10	S9579_045_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	100		1				31	60	90	1			90				31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	046	0		29	10	S9579_046_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					966.38	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	046	0		29	10	S9579_046_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	046	0		29	10	S9579_046_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	046	0		29	10	S9579_046_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	046	0		29	10	S9579_046_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	047	0		29	10	S9579_047_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	047	0		29	10	S9579_047_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	047	0		29	10	S9579_047_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	047	0		29	10	S9579_047_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	047	0		29	10	S9579_047_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					964.94	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	048	0		29	10	S9579_048_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	048	0		29	10	S9579_048_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					1015.69	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	048	0		29	10	S9579_048_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	048	0		29	10	S9579_048_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	048	0		29	10	S9579_048_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	049	0		29	10	S9579_049_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	049	0		29	10	S9579_049_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	049	0		29	10	S9579_049_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	049	0		29	10	S9579_049_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	049	0		29	10	S9579_049_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					977.10	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	050	0		29	10	S9579_050_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	050	0		29	10	S9579_050_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	050	0		29	10	S9579_050_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	050	0		29	10	S9579_050_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	050	0		29	10	S9579_050_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					964.94	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	051	0		29	10	S9579_051_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	051	0		29	10	S9579_051_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	051	0		29	10	S9579_051_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	051	0		29	10	S9579_051_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	051	0		29	10	S9579_051_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					964.98	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	052	0		29	10	S9579_052_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	052	0		29	10	S9579_052_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	052	0		29	10	S9579_052_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	052	0		29	10	S9579_052_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					966.67	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	052	0		29	10	S9579_052_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	053	0		29	10	S9579_053_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	053	0		29	10	S9579_053_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	053	0		29	10	S9579_053_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	053	0		29	10	S9579_053_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	053	0		29	10	S9579_053_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					958.05	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	054	0		29	10	S9579_054_0	5	5	Specialty Tier	1	4	010010	1	1		111	01	100		1				31	60	90	1			90				31		31													977.65	33	33	33					995.06	33	33	33							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	054	0		29	10	S9579_054_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	100		1				31	60	90	1			90				31		31									2.90	90.00	180.00	270.00					3.06	95.00	190.00	285.00								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	054	0		29	10	S9579_054_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				31	60	90	1			90				31		31									0.00	0.00	0.00	0.00					.16	5.00	10.00	15.00								0.00																		5.00				.16	5.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	054	0		29	10	S9579_054_0	5	2	Non-Preferred Generic	1	4	000100	1	2		111	01	100		1				31	60	90	1			90				31		31									0.48	15.00	30.00	45.00					0.64	20.00	40.00	60.00								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	054	0		29	10	S9579_054_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	100		1				31	60	90	1			90				31		31									1.29	40.00	80.00	120.00					1.45	45.00	90.00	135.00								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	055	0		29	10	S9579_055_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	055	0		29	10	S9579_055_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					983.18	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	055	0		29	10	S9579_055_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	055	0		29	10	S9579_055_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	055	0		29	10	S9579_055_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	056	0		29	10	S9579_056_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	056	0		29	10	S9579_056_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	056	0		29	10	S9579_056_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	056	0		29	10	S9579_056_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	056	0		29	10	S9579_056_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					970.93	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	057	0		29	10	S9579_057_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	057	0		29	10	S9579_057_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	057	0		29	10	S9579_057_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	057	0		29	10	S9579_057_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					972.87	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	057	0		29	10	S9579_057_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	058	0		29	10	S9579_058_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	058	0		29	10	S9579_058_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	058	0		29	10	S9579_058_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	058	0		29	10	S9579_058_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	058	0		29	10	S9579_058_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					1019.56	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	059	0		29	10	S9579_059_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					978.42	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	059	0		29	10	S9579_059_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	059	0		29	10	S9579_059_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	059	0		29	10	S9579_059_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	059	0		29	10	S9579_059_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	060	0		29	10	S9579_060_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	060	0		29	10	S9579_060_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	060	0		29	10	S9579_060_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	060	0		29	10	S9579_060_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	060	0		29	10	S9579_060_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					953.70	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	061	0		29	10	S9579_061_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	061	0		29	10	S9579_061_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	061	0		29	10	S9579_061_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	061	0		29	10	S9579_061_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					1011.16	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	061	0		29	10	S9579_061_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	062	0		29	10	S9579_062_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	062	0		29	10	S9579_062_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	062	0		29	10	S9579_062_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	062	0		29	10	S9579_062_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	062	0		29	10	S9579_062_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					955.41	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	063	0		29	10	S9579_063_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	063	0		29	10	S9579_063_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	063	0		29	10	S9579_063_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	063	0		29	10	S9579_063_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					964.99	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	063	0		29	10	S9579_063_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	064	0		29	10	S9579_064_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	064	0		29	10	S9579_064_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	064	0		29	10	S9579_064_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	064	0		29	10	S9579_064_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	064	0		29	10	S9579_064_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					991.71	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	065	0		29	10	S9579_065_0	5	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	065	0		29	10	S9579_065_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	065	0		29	10	S9579_065_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	065	0		29	10	S9579_065_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					980.02	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	065	0		29	10	S9579_065_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	066	0		29	10	S9579_066_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	31	60	90				1			90				31		31	0.00	0.00	0.00	0.00																								0.00																		0.00				0.00	0.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	066	0		29	10	S9579_066_0	4	2	Non-Preferred Generic	1	4	000100	1	2	111		01	100		1	31	60	90				1			90				31		31	0.64	20.00	40.00	60.00																								50.00																		20.00				0.64	20.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	066	0		29	10	S9579_066_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	31	60	90				1			90				31		31	1.45	45.00	90.00	135.00																								115.00																		45.00				1.45	45.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	066	0		29	10	S9579_066_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	31	60	90				1			90				31		31	3.06	95.00	190.00	285.00																								240.00																		95.00				3.06	95.00		Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	066	0		29	10	S9579_066_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	31	60	90				1			90				31		31					856.74	33	33	33																							33																	33				33	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
